Healthcare seems to be a discussion that just will not go away. Fine. I’ll bring it up. Again…
First off, let’s stop calling it. ‘healthcare,’ as ‘healthcare’ involves things like diet and exercise, and unless you are going to force Americans to eat better and to exercise, we are never going to be a world leader in healthcare. America has an obesity problem caused by fast food, a lack of exercise, and other poor lifestyle choices. Anyone who wants to restrict those choices is a totalitarian, and unworthy of office (hello Michael Bloomberg), and those who promise to make America healthy without restricting choice are not capable of carrying a rational discussion.
The best we can do is to educate the public on what is, and is not, healthy. And even doing that requires what many today consider ‘body-shaming’. How do you encourage a healthy lifestyle without calling anyone fat?!?
The real phrase is ‘medical care,’ and if you measure medical care, looking at cancer survival rates, recovery rates from heart surgery, and things like that, not only do we already have the highest quality medical care system in the world, but it is not even close. We have far and away the highest quality of medical care in the world. Bar none.
Second, let’s stop using the word ‘universal’ in relation to medical care. If medical care were truly universal, anyone could get whatever medical care they want, whenever they want it. There is not a nation on Earth that offers any such thing – there is not even a single nation on Earth that offers anyone whatever medical care they NEED whenever they NEED it.
Every system rations care.
The systems Bernie Sanders wants to emulate use government bureaucrats, and wait times, to ration care. In most countries, if someone 70 or older is diagnosed with cancer, they will be offered no more than end-of-life care (aka ‘pain management’), even if their cancer is treatable and they are otherwise healthy. Why? Because cancer treatment is expensive, and government rationed systems prefer to spend their medical care resources on younger patients. At seventy, your life is no longer valuable to government bureaucrats.
Good luck getting a knee replacement in a government-rationed system. The scant doctors available have vastly more important things to do than to replace someone’s knee. If you have a bad knee, under Bernie’s system you’d just have to live with it.
Some systems offer government-rationed care, and allow private care to run alongside it. If you have symptoms of cancer, in such a system, and you want to live, you might go to a private doctor and pay out of pocket, such that you can get diagnosed and treated while you still have a good chance of recovery – but you’ll pay for that yourself, and you’ll pay for it AFTER having already paid for treatment not received under a government-rationed system.
Does paying twice sound like a good system to you?
Bernie Sanders does not believe that rich people should have better care than poor people, and so he would ban all medical care not paid for by Medicare (as well as banning all supplemental insurance). This way, a rich 70 year old will not be able to get treatment a poor 70 year old would be denied – they can both die together.
Letting older people die saves money, and though Bernie is not going to say that on the campaign trail, rest assured that if Bernie gets his way, many older people will Rest In Peace years before they needed to die.
The fact of the matter is that there is an unholy trinity at work in every market for every good or service that exists, involving quality, cost, and universality. All systems can control costs, improve quality, or provide universality. Any system can do two of those three things, but no system can do all three.
No system can do all three, and if you are not willing to accept that fact, you are not worth discussing this with. You may like to believe in the land of fairy dust and unicorns, but in the real world we have to deal with reality…
Cuba does all three, but they use three different medical care systems to do it. Cuba has a thriving medical tourism industry, that offers some of the highest quality medical care in the world, at remarkably low cost, to anyone who wants to travel to Cuba for that care, but they charge for that care, and it is not available to the Cuban people (other than to government / party officials) – even if they have the money.
Cuba also has a very good medical care system for government/party officials. This system is not as high of quality as is the tourist medical care system, but it is still a relatively high quality system, and it is free, albeit not universal (only government / party officials can use it).
The third system is for the Cuban people, and it is exactly the kind of ‘free’ system you would expect from a third-word country. It’s free, and wait times are actually very low, but you would be lucky if your doctor has so much as a bandaid to treat you with. This is what ‘universal’ looks like…
Isn’t it ironic that the best of these three systems is essentially a free market system (available to anyone who can pay for it, except the Cuban people)?
Michael Moore can make all the movies he wants about Cuba’s tourist medical care industry, and Michael Moore can even lie to us, and tell us that this system is what all Cubans get, but understand that Michael Moore is a liar.
Also understand that Michael Moore is fat, and his HEALTHcare outcomes are going to suck in any medical care system – though he is rich enough to do better than most fat people.
The real question is not one of utopian dreams anyone can promise, but that nobody can deliver. The real question is one of tradeoffs. How much quality are you willing to pay for, and how will you ration care?
Bernie wants to use price controls to ration care. Price controls cause shortages, so Bernie wants to use wait times, along with a triage system, to ration care. You’ll be able to see a doctor for free, but only if whatever it is that ails you passes triage, and only after you have waited however long it takes for a doctor to become available – even if that proves to be too late.
Rand Paul had a proposal (one Trump endorsed) that would restore our medical care to much more of a free market. This would radically reduce cost while improving quality, but it would not be universal. Those who need care would be expected to pay for it, and those who cannot afford it would be treated as the exception rather than the rule (such as with Medicaid). Those who can afford insurance and decide to go without would be risking bankruptcy…
Personally, I think the system that provides the highest quality of service at the lowest possible cost is the best tradeoff. Quality provides the best outcomes, and low costs provide care for the most people possible. That makes me a fan of free markets.
If someone believes a different tradeoff is preferable, I’m open to discussion, but only if the people I’m discussing it with are honest. Those who call for systems that violate the unholy trinity – I’m sorry, but if you are not willing to discuss tradeoffs, you are not serious, and are not worth talking to.
And if you think Bernie, or any other politician, can deliver the impossible, please stay home this November, as your vote will not contribute to a rational dialog.
Politicians can promise anything, but I am not interested in what they promise unless it can also be delivered, and deliverable promises involve tradeoffs.
Note that if you share this post – and I encourage you to do so – you’ll see a lot of responses from people who do believe in fairy dust and unicorns (at least as far as medical care is concerned), and you’ll get a lot of arguments from people showing data on HEALTHcare outcomes rather than medical care outcomes.
You’ll get very little rational discussion from those opposed to free markets…
