More Thoughts on Medical Care

A local doc (surgeon) had a piece in the West Hawaii paper Tuesday advocating for more government healthcare. I couldn't resist submitting a response. Here it is:

Dr. Bairos’ recent Viewpoint repeated several arguments frequently made in favor of the current health care reform proposals. They need further examination.

1. He points out that our emergency rooms are often utilized by patients that would have been more efficiently served if they had seen a doctor earlier -- before there was an emergency. He suggests that the problem is a lack of insurance. Most patients in our emergency rooms on the island have insurance -- often medicaid. Overuse of the emergency room most often occurs either (i) because the patient does not have a primary care physician due to the doctor shortage and the fact that some doctors will not take medicaid patients due to the low reimbursements, or (ii) because the patient failed to use good judgment and attend to his problem in a timely manner. A lack of insurance is not a primary cause of such over use.

2. We are frequently told that U.S. health care is not as good as that of other industrialized countries. The statistics cited are misleading. Higher infant mortality is primarily the result of more low birthweight babies, in turn the result of more teenage pregnancies. Our lower life expectancy is primarily the result of our obesity and other unhealthy lifestyle choices. Neither will be improved by government health insurance (unless diet and exercise are mandated as a condition of obtaining medical care). A better comparison would be the survival rate from breast or prostate cancer or from heart disease. I suspect the U.S. is near the top in these areas.

3. I agree with Dr. Bairos that insurance does not lower the cost of medical care, it increases it – both through the insurance company’s administrative costs and through the costs incurred by the provider. Consequently, it makes no sense for us to be using insurance to pay for routine medical care. It is analogous to buying car insurance to cover oil changes. It would be more cost effective for us to buy high deductible policies (say $5,000 per year) for the unexpected medical crisis and to pay for our routine medical needs ourselves. If that seems unaffordable, consider that the premium for an individual insured by HMSA is currently about $5000 per year. If a high deductible policy cost half that amount, the difference could be set aside, perhaps in a medical savings account, to pay for our routine needs. Moreover, if we were paying for our own care, we would be more cost conscious and concerned about the value received for the payment.

4. The founding fathers never intended that my right to “life, liberty and the pursuit of happiness,” included a right for me to have my medical care paid for with taxes on my neighbor. Many of our society’s values have been undermined by a greater reliance on the government. Many no longer feel obliged to support charitable efforts because they believe that the government has assumed those responsibilities – and they gave (through taxes) at the office. Beneficiaries of private charity generally feel grateful for the generosity of the donors. Beneficiaries of government programs more often feel “entitled.” An assurance that the government will take care of us has undermined our sense of personal responsibility to provide for our own needs.

Food and shelter are even more basic needs than medical care. As yet, we haven’t had a call for government programs to provide for these.