Monday, October 5, 2009

What is and isn't included in health care costs?

Much has been made about the fact that Americans on average spend far more for health care than citizens of other countries and that we still lag those countries in measures of health care outcomes. But there are a lot of questions about what should and should not be counted as health care. One example is cosmetic surgery. This is not covered by health insurance, but it is included in calculations of health care costs. We are paying doctors for breast implants instead of providing health care. Mental Health care costs are also included, as are dental care and elective procedures such as in vitro fertilization. These items are legitimate costs, but their inclusion skews the picture of how much we spend on health care relative to other countries.
Another cost is long-term care. I do not mean to diminish it's importance, but costs could be dramatically reduced if multi-generational households were the norm as they are in many other countries. If I pay $20,000 a year to put my mom in a nursing home, then it is a health care cost. If I give up $20,000 in possible earnings to take care of my mom, then it is not treated as a health care cost. These two situations should be treated the same in order to properly compare health care costs.
American doctors are also paid a lot more than their foreign counterparts. One reason for this is the time and money doctors must devote to their education. In many other countries, medical training is provided by the government, or at least subsidized to a greater extent. in the US the cost of education is indirectly included in health care costs through the higher payments to doctors. In other coutries, these costs are not included in health care costs because they are costs of education.
It may be true that we spend more on health care, but the numbers don't tell the whole story.

Universal Health Insurance

If we really want universal health insurance then we can easily acheive it. I can personally grant every American health insurance right now. It covers anyone at all, there are no restrictions against pre-existing conditions, it is free, it covers anything the doctor and patient want done, and patients can go to any doctor they want. The key is that the plan reimburses the doctor $1 for each patient he sees during the year. So, now EVERYONE has insurance and the problem is solved.
Obviously not. All the talk about the uninsured and the need for insurance reform misses the point that it is health care and not health insurance that matters. No one dies from a lack of insurance, despite the headlines on a recent report, they die from not receiving medical care. There is a difference between health insurance and health care and people would be wise to understand the difference before making reforms.
If doctors won't treat people covered under the insurance plan then no one receives any health care. The government could FORCE doctors to accept patients, which is already occuring with Medicare reimbursement guidelines and will only increase under proposed reforms. The problem with this is that it will lead to a serious shortage of doctors. We alreay have severe shortages in nurses and general practitioners in part due to the reimbursement schedule.
Besides, it is wrong to FORCE doctors to treat patients. Of course, it is equally wrong to FORCE someone else to pay the doctor to treat patients. In both cases, someone is being forced to work without compensation. In one case the doctor is forced to treat patients, in the other case someone is forced to work for free as his wages go to the government in the form of taxes and ultimately to doctors. If you pay 35% of your income in taxes, then you are being forced to work for free 35% of the time.
A fairer system would involve voluntary exchange and would not have to involve government at all. A non-profit health insurance company could be set up that would accept any and all patients and the health care costs would be funded through tax-deductible contributions. If the American public does indeed care about the uninsured and wants to provide health care to everybody, then this is the way to do it.
Will this work any better than my first insurance plan? Probably not. This whole debate isn't about providing health care, it is about power. It is about making someone else do something that people are not willing to do themselves.