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No Such Thing as Free Health Care

July 24, 2009

There are two talking points President Obama keeps on using when discussing his health care plan (although that stretches the term a little) to which the French Cowboy would like to say something.

One: Obama’s lamenting the fact that when someone without health insurance needs emergency treatment “the rest of us have to pay for it.” Well, this is true, of course, at least in those cases in which the patient really won’t pay for the treatment. Yet Obama implies that under his health care system “the rest of us” won’t have to pay for other people’s treatment or, put differently, that everyone will pay for his own visit to the ER. This, of course, is blatantly false. The entire concept of the health care ‘reform’ Obama is trying to push down the American people’s throat is based on the idea of nation-wide (mandatory) solidarity: All pay into the pool of money (or rather debt) and all get something out of it. Some will pay more into the pot than they get out of it and cover the cost created by those who pay less than the actual cost for their treatments. Obama’s hope is that precisely because some – namely the rich and the healthy – will be forced to participate in this scheme there will be a reduction in health care costs for enough other people to keep him popular.

The difference between the current situation in which, in theory, an uninsured person’s emergency treatment is paid by “the rest of us” and the plan Obama has, is that in the latter case everyone will be enrolled into a nation-wide insurance contract whether they like it or not. Also, a gigantic government bureaucracy will be set into place in order to pursue the Sisyphean goal of reducing health care costs. What will not change is the fact that some pay the medical costs of others.

What makes less likely the prospect of an overall reduction of health care costs when everybody’s forced to buy some sort of insurance, either through their own means or through social subsidies, is that, not only will the rich and the healthy be pulled in to make net payments, but also those who are currently uninsured. Once enrolled into a national health care system, the formerly uninsured are likely to increase their demand for medical treatment. Both groups – those who have to involuntarily pay for health care themselves and those who will receive health care as a social benefit – will be prone to raise their respective demand for treatment since it’s already paid for anyway and they will never see the money in any other form.

Two: Obama, among with many others, claims that through “preventive care” “lives and money” will be saved. Well, in some cases this may be true. But it is naive to believe that health checks will reduce costs. A recent study about mammograms (a procedure Obama used himself as an example) suggests that finding potentially dangerous cancer cells results in a ratio of unnecessary treatments to necessary ones of 1:2. Now consider that unnecessary cancer treatment doesn’t come for free. Not only is it costly financially, it also comes with physical side effects and learning that you have cancer is taxing in emotional terms. Whether cancer cells are going to really affect a person’s wellbeing should they go untreated is impossible to know before the fact. So, usually, a responsible doctor would recommend treatment just to be on the safe side.

Évidemment, screening programmes are a good thing for every case in which they actually save a life or prevent the development of serious health issues. Yet they also tend to augment the number of unnecessary treatments. In addition to the non-pecuniary cost to this (born by the patients and their loved ones), the budget effect of unneeded treatments is negative.

And while, sans doute, a healthy lifestyle can reduce the likelihood of medical issues to some extent, illnesses are a fact of life and no number of “Healthy Eating” classes will change that. The danger of putting too much hope into preventive care is that you may end up thinking that people who fall sick have only themselves to blame. High blood pressure? Well, stop being such a hothead! And don’t eat so much salty food! Inherited anemia? Then why the heck didn’t your mother abort you?

Ultimately, if you want to minimise illnesses, you will have to minimise life. Vous savez comment ça marche…

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