|
Jewish World ReviewDec. 3, 1998 /14 Kislev, 5759
Thomas Sowell
The health care "crisis"
SINCE VIRTUALLY EVERYTHING is called a "crisis" these days, perhaps we should not be
surprised to hear about a health care "crisis." Still, those of us old-fashioned enough to
believe that words should have some meaning may wonder just what this crisis consists of.
Are we getting worse health care than in the past? Worse than the rest of the world? Worse
than we would like?
The answer to the first two questions is clearly "no." Our doctors today can cure or prevent
diseases that were virtually an automatic death sentence in the past. People from other
countries --- even rulers of some other countries --- come here for medical treatment, while
few Americans go overseas to get medical care.
If our standard is whether we are getting worse than we would like, that applies to
virtually everything, not just health care. I could be driving a newer, more powerful and
more luxurious car. I would like to have a body like Arnold Schwarzenegger's, a brain like
Einstein's and a voice like Pavarotti's.
While some things, like brains and voices, are gifts of nature, even these can usually be
improved if we are willing to sacrifice the time to work on them. Other sacrifices, whether
of money or time, can improve other things. The real problem is that we are not willing to
make some of these trade-offs.
Fine. But don't turn it into a "crisis" because what you want has a cost. Everything has
always had a cost.
Virtually every aspect of the so-called health care crisis boils down to the fact that
everybody wants somebody else to pay for health care.
Health Maintenance Organizations have been criticized for getting mothers out of hospitals
too soon after childbirth. But HMOs cannot force any mother to leave a hospital. They can
only stop paying and let others decide whether it is worth the cost to continue staying.
Alternatively, the HMOs can charge higher fees and cover longer stays after childbirth.
The basic underlying fact that is not going to change is that medical care is costly,
whether those costs are paid by HMOs, the government, the patients or anybody else. We can
try to pretend that these costs don't exist or hope to force somebody else to pay them, but
none of that changes the costs or the fact that they have to be paid.
With our country's record prosperity, surely it is not too much to expect adults to face up
to trade-offs. We are not talking about going hungry so that a child can have an appendix
removed. We are talking about not eating out as often, or not buying so expensive a watch, so
that a mother can spend another day or two in the hospital.
Politicians see all this very differently. They leave trade-offs to economists, who don't
have to get elected. Politicians win votes by passing laws creating "rights" for patients to
get this or that, without either providing any money to cover the costs or expecting the
patients to cover the costs. The additional costs will be left to be paid "somehow."
It is a great game for those in the business of getting re-elected. But the costs don't
disappear, no matter how much they are shuffled around.
When the government tried to shift the costs of medical care for the elderly onto HMOs, the
HMOs started getting rid of elderly patients. Whether HMOs are good, bad or indifferent, they
are just one way of delivering medical care. If there are better ways, people are free to
find them. What is not free are more medical "rights."
How did we ever get into the present mess in the first place? There was a time when a
patient simply went to a doctor and paid for treatment. The costs and the trade-offs these
would entail were very plain to everyone. If it was worth it to get a broken arm fixed, but
not worth it to go in every time you had the sniffles, then you made such choices
accordingly.
Employer-paid "fringe benefits" began during World War II, as a way to get around
government-imposed wage and price controls, when employers needed to hire more people but
were prevented from attracting them with higher pay. Politicians found it expedient to exempt
these benefits from the heavy taxes they put on money income. From this has followed the
grand illusion of something for nothing, which has created needless problems in health care,
as it has in so many other aspects of
11/3o/98: Knowing what you are talking about
11/23/98: The impeachment legacy
11/23/98: Random thoughts
11/19/98: Tales out of bureaucracies
11/16/98: Scholarships based on scholarship
11/12/98: Forward march
11/09/98: Moral outrage
11/05/98: Will the Republicans ever learn?
11/02/98: A voter's duty
10/30/98: The poverty pimp's poem
10/29/98: Random thoughts on the election
10/27/98: "Partisan" and "unfair"
10/23/98: Ed-u-kai-tchun
10/21/98: McGwire, Maris and the Babe
10/20/98: MURDER IS MURDER!
10/16/98: Lightweight Boxer
10/14/98: A strange word
10/09/98: Impeachment standards
10/08/98: Alternatives to seriousness
10/07/98: Heredity, environment and talk
10/02/98: A much-needed guide
10/01/98: Starr's real crime
9/24/98: Costs and power
9/18/98: Are we sheep?
9/16/98: Judicial review
9/15/98: Hillary Rodham Crook?
9/14/98: Taking stock
9/11/98: Moment of truth
9/04/98: Random thoughts
8/31/98: The twilight of special prosecutors?
8/26/98: "Doing a good job"
8/24/98: America on trial?
8/19/98: Played for fools
8/17/98: A childish letter
8/11/98: Hiding behind a woman
8/07/98: A flying walrus in Washington?
8/03/98: "Affordability" strikes again
7/31/98: Random thoughts
7/27/98: Faith and mountains
7/24/98: Clinton in Wonderland
7/20/98: Where is black 'leadership' leading?
7/16/98: Do 'minorities' really have it that bad?
7/14/98: Race dialogue: same old stuff
7/10/98: Honest history
7/09/98: Dumb is dangerous
7/02/98: Gun-safety starts with
parental responsibility
6/30/98: When more is less
6/29/98: Are educators above the law?
6/26/98: Random Thoughts
6/24/98: An angry letter
6/22/98: Sixties sentimentalism
6/19/98:Dumbing down anti-trust
6/15/98: A changing of the guard?
6/11/98: Presidential privileges
6/8/98: Fast computers and slow antitrust
6/3/98: Can stalling backfire?
5/29/98: The insulation of the Left
5/25/98: Missing the point in the media
5/22/98: The lessons of Indonesia
5/20/98: Smart but silent
5/18/98: Israel, Clinton and character
5/14/98: Monica Lewinsky's choices
5/11/98: Random thoughts
5/7/98: Media obstruction of justice
5/4/98: Dangerous "safety"
5/1/98:
Abolish Adolescence!
4/30/98: The naked truth
4/22/98: Playing fair and square
4/19/98: Bad teachers"
4/15/98: "Clinton in Africa
"
4/13/98: "Bundling and unbundling
"
4/9/98: "Rising or falling Starr
"
4/6/98: "Was Clinton ‘vindicated'?
"
3/26/98: "Diasters -- natural and political"
3/24/98: "A pattern of behavior"
3/22/98: Innocent explanations
3/19/98: Kathleen Willey and Anita Hill
3/17/98: Search and destroy
3/12/98: Media Circus versus Justice
3/6/98: Vindication
3/3/98: Cheap Shot Time
2/26/98: The Wrong Filter
2/24/98: Trial by Media
2/20/98: Dancing Around the Realities
2/19/98: A "Do Something" War?
2/12/98: Julian Simon, combatant in a 200-year war
2/6/98: A rush to rhetoric