Saturday, February 19, 2005

More Hyman Healthcare Humbug

Every once in a while, Mark Hyman stumbles across an apt metaphor. Usually, however, it’s appropriate for precisely the opposite reason Hyman uses it.

Such is the case in Hyman's comparison of healthcare with Jiffy Lube (the quickie oil-change franchise). Why, wonders Hyman, can’t our healthcare system be more like the folks at Jiffy Lube, who regularly remind him he’s due to get his oil changed and who “sometimes find problems I didn't know existed?” [Note to self: look into ownership of Jiffy Lube stock by corporate officers at Sinclair Broadcasting.]

The problem is that health care is already too much like Jiffy Lube. There are rampant rumors that the problems Jiffy Lube “finds” for folks like Hyman aren’t actually problems at all (or at least don’t exist until Jiffy Lube mechanics get their hands on the car). Why would people think that Jiffy Lube would cheat their customers? After all, they’re in the business of making our cars run smoothly, right?

Wrong. They’re in the business of making money. To the extent this goal overlaps with fixing your car, fine. But the goal of any private company is to turn a profit. Everything else is simply a means to that end.

That’s fine (up to a point) when the issue is getting your oil changed or manufacturing widgets. The free market system can be an elegant tool in maximizing efficiency in some contexts.

But not in the case of healthcare. Why is this? Because the issue of healthcare involves two central issues not in play with oil changes: shared consequences and ethics. It doesn’t affect you if my car seizes up because I haven’t changed the oil in the last 30,000 miles. Your car still runs like a top. But if I have a cold, I might spread it to you or your family. If I break my leg and you are my employer, my condition costs you money. If I have cancer and die young, perhaps my widow and children will end up going on welfare. As much as we Americans like to think of ourselves as rugged individuals, the fact is we’re entwined with each other’s lives in a myriad of ways. Our health (and the consequences of it) are one of the most concrete and obvious ways this manifests itself.

And ultimately, we recognize this. This is where the issue of ethics comes into play. Even the most hard-hearted of conservatives (with the possible exception of Bob Novak) would not suggest that those without health insurance or the means to pay for treatment should be left to rot. If your car breaks down, you won’t get it fixed for free. But if you don’t have a cent to your name and have a heart attack, you’ll presumably get treated in your local emergency room anyway. It will cost the rest of us in increased healthcare costs, but we’re willing to do that as a matter of principle.

That’s where the Invisible Hand of capitalism comes down with a crippling case of arthritis. When it comes to issues that connects all of us to one another physically, financially, and ethically, the free market fails us.

Hyman asks rhetorically “if the government has ever run anything efficiently.” Well, how about national defense? The Pentagon is arguably the most bloated and wasteful of our government agencies. Therefore, shouldn’t we privatize it to increase efficiency (“Now entering Fallujah, the Oil of Olay 82nd Airborne Division!”)?

In this case, even Bob Novak would agree that the government is the right tool for the job. We instinctively understand that when it comes to our collective national defense, we are far better off pooling our resources together rather than parceling out the job to a bunch of entities driven by the motive of profit. $800 toilet seats aside, working together is still the most efficient option when it comes to ensuring our collective safety.

And so it is with health care. HMOs don’t care about your health beyond the extent to which it affects their own bottom line, and the drive to maximize profit ends up leading to inefficient ways of approaching health care issues on both a collective and individual level.

There’s plenty of proof to back this up. A recent study showed that although the U.S. pays far more on helthcare as a percentage of its gross domestic product than any other country for health care, we’re embarrassingly far back in the pack when it comes to what we get for our money. The most efficient country in terms of healthcare spending? Hyman’s favorite place: France. They may be “cheese-eating surrender monkeys,” but at least they’ve got their health, eh Mark?

Don’t believe in the word of number crunchers? How about a Harvard doctor? As Dr. Arnold S. Relman said in testimony to a Canadian government panel on healthcare, the U.S. system of privately funded insurance is one of the least effective ways of delivering healthcare. The profit motive causes far more problems than it solves.

Maybe you think a doctor is too soft-hearted and caring to be objective about the hard facts of healthcare delivery. In that case, take a look at this brief but cogent statement by Dr. William Roth, a professor of management theory, who debunks several of the standard myths used by opponents of national healthcare.

The only way to create a system that succeeds, both in terms of financial realities and ethical imperatives, is some model of single payer healthcare system. No healthcare delivery system that fails to cover more than 45 million Americans (many of them children) is not efficient by any definition that matters. We all pay the price for this failure in any number of ways. As long as the profit motive is the driving factor in providing healthcare, the system will fail us. Just as we shouldn’t put our collective national defense in the hands of private firms that are motivated by profit rather than providing protection, we shouldn’t put our collective defense against accident, illness, and injury in the hands of HMOs who are more influenced by accountants than doctors.

And that’s The Counterpoint.


At 9:14 PM, Blogger Doctor I said...

One of the issues you don't discuss, but which is important and should be added to the debate, is the poor quality of private insurance funded healthcare.

Here the Jiffy Lube metaphor breaks down entirely. If I'm attempting to save money I can do my own oil and not worry about all the other fluids and valves that Jiffy Lube will attempt to sell me on my visit. I can't tend to my health care on my own as well as I can working with my physician.

But many health care plans are very high priced and carry high copayments and deductibles. My plan, for example, requires a $30 deductible for every office visit. The co pay does not count in the deductible, nor in the coinsurance. I'm also required to pay a $30 copay on every prescription I fill at the local pharmacy, and $75 for every prescription through their mail order prescription. The company's portion of the doctor's visit is slightly under $12, and their portion of my particular prescription is $25. The cost to my employer for this coverage is approximately 250 per month.

Thus, I choose, even though fully employed, to neglect taking care of problems that are chronic but not debilitating and not life threatening. I probably put off getting other attention. I certainly don't worry about preventive care. I can't afford to.

This system is not run for the health of the patient, nor for the good of those who practice medicine. It is run for the executives in the Insurance industry.

At 2:26 PM, Anonymous Anonymous said...

You wrote:
No healthcare delivery system that fails to cover more than 45 million Americans (many of them children) is not efficient by any definition that matters
double negative

Should read:
No healthcare delivery system that fails to cover more than 45 million Americans (many of them children) is efficient by any definition that matters

At 9:50 AM, Anonymous Anonymous said...

The following sentence needs to be editted:

"No healthcare delivery system that fails to cover more than 45 million Americans (many of them children) is not efficient by any definition that matters."

It should read one of two ways:
1. A healthcare delivery system...
is not efficient..... [or]
2. No healthcare system....
is efficient....[my preference]

Myron Biggs

At 1:38 AM, Anonymous Anonymous said...

I believe the UK (A paragon of socalized medicine), treats its whole population from cradle to grave for the same percentage of GDP as Medicare in the US.
The criticism is made that the UK does not have the same quality of health care as the US. Under one of the best measures of health care effectivenes, longevity , the UK and US ae equal (what other measure is best?). As an (ex) Brit, I'd be happy to argue this toe-to-toe with anyone in the US (bring them on!!). The US medical system is not broken, its optimized to extract the maximum amount of money from the consumer, so it's a capatilist triumph -- it meets it's objectives.

At 10:10 PM, Anonymous Anonymous said...

Actually, the UK spends approximately half of the percentage of GDP on healthcare that the US does. (approx 7.7% to 14.6% in 2002, rising slightly higher for the two years that follow, various sources give various slightly differing figures).

Privately funded healthcare is more expensive because there is a positive incentive at every point in the chain for costs to be inflated so that everyone involved can make more money. A government-funded socialist healthcare system may become inefficient, but its main aim is treating the sick, not making money.


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