Health Care Is a Business, Not a Right

"People need a lot of things. You’ll die without food long before you’ll die without health care, and yet few people say we need to “take the profit motive out of farming”."

"Why is health care Special"

I tell you why healthcare is special. You cannot buy healthcare at the cost of food. I can buy ramen noodles and survive for cheap. Sure it is not the best but I won't frikin die. But If I get cancer and cannot afford a 100k Bill (yes, I know a family member who got that bill) , I will die. See ?

Again, people are talking about making Healthcare a right in America is mostly due to the fact that it is too expensive and difficult to deal with. If that was not the case and healthcare becomes as cheap as food, I bet people will stop the whole "healthcare is a right" movement. I would.

EDIT: Read this fun fact [0]. The average cost of health insurance is $17,500 PER FAMILY . Now this means that you may get covered for diseases such as Cancer but that does not mean you won't get a huge bill even after insurance. Now imagine you had no insurance and you get cancer. Compare this to average cost of food [1] for a family of 4

[0] http://www.ncsl.org/research/health/health-insurance-premium...

[1] http://www.cnpp.usda.gov/sites/default/files/CostofFoodFeb20...

The conclusion of the article is a bit ridiculous. tl;dr healthcare isn't a right because we can only spend a finite amount.

Yeah, ok, but that dismisses priority entirely. Scarcity is still in play, so you treat the immediate needs first. I think we do have capacity in the healthcare system to do it that way. The author of the article basically bucketed a sprained ankle and a stroke in the same category, and concluded, nope, we don't have enough money to treat all that cancer, heart attack, stroke and scrapes and bruises equally, so it can't be a right. I guess, but who's really arguing for the right to get an ace bandage right now? Just because we have to prioritize access doesn't mean healthcare can't be a right. Today we prioritize by medical need and by who can pay. Single payer means everyone can pay, so prioritize by medical need. The right can be subject to objective need.

But it's not a business, not in its current implementation. Right now it's a implicit government protected monopoly for lots and lots of things. Case in point: EpiPens which are in the news today. When the government makes it hard to develop alternatives but doesn't pay for the monopoly it creates, it's neither a business nor a right. It's a disaster yet that's where we find ourselves today.

http://www.nytimes.com/2016/08/24/upshot/the-epipen-a-case-s...

The article does raise an interesting point in that most people don't necessarily see food as an inalienable right that people shouldn't need to pay for.

But to counter that point our government has set up a system of farm subsidies and management to ensure affordable food is available to pretty much anyone... and even those who don't have the money get food stamps.

Seems like the government tries to do the same thing with the health sector, yet it still costs more than most people can reasonably afford. It seems like there are clear market pressures and competition in food production that drives the price down to a minimum. That does not seem to be the case with health care.

This is absolutely spot on.

Health care is not a right, neither is education, food, or access to the internet.

These are all things that people at some point or another have claimed as "inalienable human rights".

There is always a cost benefit analysis here. Should we perform this extremely expensive treatment to give somebody a few days in agonizing pain, or maybe save a few dozen other people with a simple, straightforward procedure?

The painful part is realizing that no matter what, people with more resources (money or otherwise) will have better (and longer) lives on average then people without resources. There is no way to legislate that away. See Venezuela for an example of that.

'Right' is probably too strong a word.

Does a person have the 'Right' to be rescued from a car accident that would surely kill them without help when it is in other people's power to do so?

No. BUT at some point I think it is fair to expect certain behavior from others living in civilized society.

A Right? Probably not. But Reasonable Expectation doesn't have the same punch as a slogan.

Despite any implementation problems, I don't believe that someone should have a worse chance of keeping their life in the face of disease just because they are not as wealthy. That alone means that society is considering some people's lives more important than others, which is not a society that I would like to live in.

Health care should probably not be a right, but universal heathcare has a lot to recommend it from a social and economic policy perspective. For example, people who can't afford to see a doctor will eventually end up in the ER, at enormous cost that can't be recouped, and that could likely have been prevented. Also, having a maximally large healthy working population is something that has a direct economic impact

There are no free markets where price transparency doesn't exist. Even surgeons can't predict what prices will be for a procedure.

Healthcare, because of the complexity of understanding how the body works, is a natural local monopoly.

Are you going to shop around for a better deal on a quadruple bypass when you already trust your surgeon? How would you know if the cheaper surgeon was as good?

Healthcare insurance suffers from the classic agency problem and has no incentive to keep costs low over the long term because they take ~7% off the top for a pass through transaction.

The current problem is the pricing is completely non-transparent hence consumers cannot choose based upon price. No one knows what anything costs until a bill arrives much, much later. In addition, it is extremely opaque how the numbers on the bill are arrived at.

> You’ll die without food long before you’ll die without health care, and yet few people say we need to “take the profit motive out of farming”

Yes, and the reason few people say that -- even while people do argue for regulation to limit certain commercial practices in farming that they view as harmful to food availability, affordability, and/or quality -- is because you don't see monopolies on basic foodstuffs in the developed world being used to drive prices on foods that people rely on so high that many people, even with the safety net provided by government, can't afford essential foodstuffs in a first-world nation like the US.

That is, because, problematic as it is, the combination of private for-profit business and government regulation operating in food markets is working adequately well, such that people are less likely than is the case for healthcare in the US to perceive that the model under which it is provided is broken, inadequate for the needs of society, and essential to fundamentally reform.

History has shown, more than once, that when the systems of delivering food are perceived to be as broken as the US system of delivering healthcare is now perceived to be, people do clamor -- often violently -- for change.

"People need a lot of things. You’ll die without food long before you’ll die without health care, and yet few people say we need to “take the profit motive out of farming”."

I'll say this too when I get a $65,000 bill at the grocery store.

I'm not sure I buy the reciprocal-altruism argument, but the article's thesis seems ineluctably true, however unsavory.

From the UN Declaration of Human Rights:

Article 25.

Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.

http://www.un.org/en/universal-declaration-human-rights/inde...

When you have a NHS you are agreeing on a single standard of care as a nation. The problem that the author illustrates is that it is difficult to have an honest dollars and cents conversation about what that standard of care should be. It certainly can't be 'whatever is necessary at any cost' without bankrupting the program. Where the dollars do get spent will be determined by political expediency rather than individual choice. As with most government programs the incentives will be with what's popular rather than what is effective. Politicians will get elected to put more money towards $cause of the day$.

Also consider the moral hazard involved with national healthcare combined with our two party system and electoral process. Who would be surprised if Iowa and New Hampshire end up with more hospitals per capita than other states? What if CA and NY end up with a lions share of the healthcare dollars? What if they don't?

IMHO, the right way to run a NHS for the US would look very different than the UK's NHS. Perhaps something similar to a minimum wage. I.E. A federal minimum standard of care that is uncomfortably low, with state and private coverage able to build on top of that as determined at a local level. But we have to be able to look at something like a "death panel" and say 'yes of course that would be necessary'. Until we can have honest conversations about varying standards of care, we won't see meaningful healthcare reform in the US.

The question the article is asking isn't matched by the headline, or the conclusion. The points raised in the article come down to this idea - if we, as a society, want to make sure everyone has access to health care, then we need to decide how to handle the limited resources available. That's true whether you think of health care as a right or not.

The government pays farmers to burn their crops, as to destroy competition and raise prices. The government, with the ACA, taxes insurance companies great amounts and uses that money to pay for the government care; the quality of the company's care goes down, then.

That's not an either-or situation. Health care, food, clothing and shelter are rights and businesses.

The rights are positive rights, in other words they must be provided, and cost resources to provide. (In contrast to negative rights like freedom of expression, where it costs resources to take the right away from you)

As positive rights (aka obligations), they must be rationed. Welfare et al provides enough money to pay for basic food & shelter but not for caviar and mansions. The article is a very reasonable discussion of why it's harder to ration health care, but the conclusion (and title) doesn't necessarily follow.

Human Rights Declaration: "Everyone has the right to life, liberty and security of person."

...and Health Care is how one stays alive, therefore health care should be a right.

I know everyone's busy re-iterate the usual health care talking points, but I this part interesting: McArdle says that she went on to a British talk show to talk about NHS and Obamacare, and the host and opponent both refused to deny that NICE does what it actually does: a CBA on treatments and recommends for/against them to the NHS.

(Obama tried to set up IPAB to do the same thing.)

This article strikes me as tone-deaf.

> People need a lot of things. You’ll die without food long before you’ll die without health care, and yet few people say we need to “take the profit motive out of farming”. (...) Why is health care special?

Why is healthcare special? Because juicing someone's wallet when they are down on their luck is one of the worst things you can do.

Yes, healthcare is not cheap. And the resources we have to pay for it are finite. We don't understand everything, and ultimately we will all lose the battle to death.

So why do we fight? Because we want to live. And most of us want to see those whom they love live too.

The money argument is especially bad though, because in terms of outcomes (whether you measure longevity, or not dying of preventable diseases, or not getting more messed up during treatment), the US scores pretty bad. Yet we spend the most of any country (per GDP)[1]. Other countries such as the UK, France or Germany spend less, do contain costs and have better outcomes.

What making it a business does is reduce overall efficiency. If the major actors have the ability to take advantage of the final customer's weakness while maintaining a fiduciary responsability to generate profits, then money that is spent for the purpose of getting well gets diverted into pure profits.

Exhibit A: drugs. In France drug companies negotiate a market price with the payor (government). They are still able to turn a profit in that market alone. Not a huge one but decent. They then take the same drug, patent it in the US and sell it for 4x to 6x the price. Keep in mind the R&D was already paid for. So that is pure profit (minus marketing and regulatory compliance costs).

[1] http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS?year_high...

It'd be nice if we were in a place where the main ideas in this article, providing the health care people can afford and no more, were somewhat applicable. Unfortunately people in the US literally cannot afford any health care of any kind, aside from over-the-counter items like Band-Aids and cough syrup and those kinds of items won't get you very far. Forgetting this, or leaving it out of the article entirely as the author of this article does, is dangerous and misleading.

It seems obvious but the article forgets to mention that since health care is so expensive and no one can afford it, everyone buys health insurance. Even health insurance has become expensive to the point that no one can afford it, people need a larger organization to help purchase this insurance on their behalf (like their employer or now, the government). Now we've reached the point were even that has become too expensive. The guy in the cube next to me broke his hand skate boarding and is spending almost 1/10th of his salary on covering the cost and he's employed.

For sure, the history of health insurance and health care in the US is complicated and it's not as straightforward. But that is where things are today: unless you are wealthy or work for a wealthy company, health care is the kind of expense that can balloon out of control, despite purchasing insurance. In my opinion, that is what people object so vigorously to: spending money on health insurance (and a lot of it) and still having to miss car and mortgage payments so that they can give more money to doctors and pharmacies and hospitals to keep their spouse or children or themselves alive. You can choose to skimp on food, few of us would choose to willingly lose a loved one because "we can't afford it."

If I had to choose what should be made non-profit, my first choice would be insurance companies. By definition, for-profit companies would like to make more profit every year. There's a clearly unhealthy co-dependency between insurance companies, pharmaceutical companies and hospitals. Fixing it all in one swoop is probably impossible, but one way to make health insurance non-profit is to make it government run. We can't seem to get that done, so now the government is trying to join workplaces in helping people to buy insurance. It's the simplest and probably the only legal solution so that's the one that is being pursued in the US. We'll see how it goes.