Friday, April 11, 2014

The problem of health care ...

From a statistical and practical point of view, the health and longevity of the citizens of the United States has dramatically improved over the past century.  Much of the improvement can be attributed to great technological changes that substituted chemical pollution for exceedingly dangerous biological pollution (i.e., automobiles that produce carbon dioxide and water instead of horses that broadcast water polluting and disease laden animal feces into the public thoroughfare and private abodes).  This has been augmented by direct local government investments in water quality, sanitation and public health efforts in pest control.  Beyond this, discoveries from medical science have added to the public health arsenal, particularly vaccination programs and a proliferation of antibiotics  Such unambiguous advances primarily served to virtually eliminate child-killing typhus, typhoid, diphtheria, polio, measles, whooping cough, tuberculosis and other now nearly forgotten diseases that harvested such a large crop of our young.

Sanitation’s success spawned a whole new set of health priorities where efforts focused on problems associated with not dying in childhood.  In particular, treatment of diseases such as cancer, diabetes, cirrhosis and heart disease that are in part causally related to the time individuals spend living indulgent or self abusive lifestyles.  

While the early achievements of technology and positive public investments served to increase longevity with amazing efficiency, the progressive public policy intrusion into the actual provision of medical care has not had such positive results in dealing with the unintended consequences of longevity.  Indeed, the progressive approach has triggered processes that are now creating a choice between the economic viability and the basic humanity of the western world.

To understand the root of the problem we face, one must understand the fundamental impulse of the progressive.  Generally, the progressive is someone who is articulate, i.e., can speak clearly and convincingly, but who cannot do much else otherwise productive.  The progressive's gifts allow the use politics to harness people who actually know how to do things in the physical world to do the progressive's will.  The progressive Zeitgeist must maintain that the common man is irretrievably ignorant because he is unable to grasp deeper truths revealed to what Sowell terms "the anointed."  In their view, only educated elites (those educated at institutions fashionable with the anointed) could hope to provide proper policy for complex social issues issues.  

Indeed, the progressive educational design attempts to insulate the ordinary citizen from things that promote, in the words of John Dewey, "pernicious individualism," that sense of personal sovereignty that is the basis for the individual initiative and innovation and that makes a person difficult to bring to the fold.  Such a system avoids inculcating the kind of knowledge and values that would make people independent and self-reliant.  The progressive education for the "masses" attempts to convince the young that achievement is somehow produced by being a docile and cooperative member of a group that will submit to the (again, Sowell's words) "vision of the anointed." 

That the vision mainly serves to provide for the individual needs of the anointed could probably go without saying.  But it comes mainly, in the form of a plethora of taxpayer funded employments filled with people who are at best 'experts in things that are mainly a matter of their opinions' -- to paraphrase Charles Shultz in "Peanuts."  

Of course since progressives are largely articulate incompetents, the only way they could approach the issue of improving health care was either to spend someone else's money on perceived or manufactured problems or to promulgate laws and regulations to control those who actually know how to promote health, cure disease or relieve pain.  

Progressive government started by directly allocating resources to benefit the health and medical care of certain classes of individuals.  Once this was in place, all of the normal public choice processes took over and the power to be gained from the discretionary allocation of vast resources to targeted groups naturally corrupted public-arena decisions.  Moreover, using government agencies to regulate the provision of services created massive opportunities for individuals to profit professionally and personally by moving between between "public service" NGO's, crony commercial interests and government agencies. 

From an economic point of view, the net result is that almost all "health care" policies promulgated by the Federal Government cumulatively involve three elements:  (1) restrictions on supply, (2)  inflation of demand, and (3) feigned surprise when prices rise.  And the rise in prices is used by the anointed as a reason for more progressive reforms.

The "Affordable Care Act (ACA)" initiative is the latest in a long string of government actions to address rising health care prices by increasing the number of people whose health care is paid for by someone else, i.e., inflating demand.  The ACA additionally restricts supply by increasing the fealty that those who know how to help people must pay to those who mainly know how to talk about it.  The ACA imposes a massive reporting burden on providers that drain existing resources.  Moreover, it interferes with efficient and effective treatment with regulations on the treatment regimes that will be reimbursed for different classes of patients.  Once more, demand is massively subsidized by wealth transfers and supply is constricted, so either price must radically increase or the anointed must step in and enforce either direct or queue rationing to, in the words of Walt Kelly's Pogo, "divide the shortages amongst the peasants."  

The consequent distress caused by the ACA now threatens to make the progressives pay a cost at least for the next election, since the incompetence of the education system designed by the progressives has left the country with a sizable number of individuals still not subjugated to the vision of the anointed.

But it is doubtful that the election outcome will offer much in the way of real solutions to the health care dilemma: To Wit: (1) massive federalization of health care finance starting with employer tax incentives, then Medicare, then Medicaid and now the ACA have centralized the economic incentives in the demand for health care; and (2) an incomprehensible regulatory morass has corrupted the development and delivery of medical technology, from drugs to diagnostic testing  to treatments available to medical devices to the very treatments prescribed and applied by medical professionals.  

Thus the normal market processes that efficiently allocate resources to continually improve products and delivery of services and drive down prices have been short circuited.  So we are left with a couple of hammers to which everything looks like nails: a Congress that can only pass bills whose effects are unknowable, or vote to repeal laws whose destructive effects have been realized but which will be vetoed by an entrenched administration that will continue in its primary quest to destroy private sector involvement in third party health care finance, leaving an apparent Hobson's choice to the hammers -- single-payer or chaos.

Our only hope is that the primary outcome of this fiasco will be to finally discredit the vision of the anointed.  This is fairly likely given that the overall progressive program has already rendered the nation insolvent.  Although the progressive program can continue to lurch forward in an insolvent nation, the bullet in the brain comes when the nation runs out of liquidity.  This happens not because the Federal Reserve can no longer create money for the Treasury, but because the money it creates is worthless.  It is likely that such a catastrophe will be endured before people can act to implement the real solutions to the problems of health care in the United States.

My next post will discuss an approach to the provision of lower cost and more effective health care that could be implemented now without material marginal government investment, but which will not be considered as long as the anointed demand control over the lives and health of the "masses" they pretend to shepherd.   

1 comment:

  1. Are there any examples of a health care system you think would be worthy of emulating? There are certainly health care tourism places (Mexico, Thailand) but is that just a factor of the difference in the standard of living?