There is a populist strain to the Democratic Party which appeals to the resentments and envy of worried and anxious voters and promises some short term palliation in exchange for long term damage. One of the areas in which Americans feel most insecure is health care. All but the very wealthy understand that a severe illness can not only destroy one's health but can also destroy one's financial security. This is a real problem, in part caused by the success of American medicine in treating illnesses which were once thought to be beyond human intervention.
On Sunday, Teddy Kennedy on FNS, among his other familiar comments, referred to the 35,000,000 Americans who lack health insurance. This is certainly a problem which needs to be addressed though the over-simplifications offered by the Democrats are likely to exacerbate the problem for all of us.
The problem with American health care is not access, it is the cost. Cutting edge health care is expensive and the only way to hold down the cost of health care is to ration its availability. We have decided to ration American health care by price. We have a two or three tier system with the top tier, available to most Americans, doing an excellent job, despite its obvious faults, in treating medical problems. Private health insurance allows for adequate (superior when compared to most countries on the planet) health care for a majority of the population. Better insurance allows for more choices but even the most basic insurance makes available state of the art technology in a timely fashion. No one has to wait more than a few days for an urgent MRI or CT Scan. Universal health care, run by government bureaucracies, is a disaster waiting to happen. It essentially rations health care by making it equally unavailable to all (though the wealthy can almost always find ways around such restrictions, often by traveling to countries with less restrictions.) England and Canada have shown that rationing health care by making it equally unavailable to everyone provides excellent health care to the healthy and poor health care to the sick.
The flaw in our system is that people have been led to believe that (almost) free health care is a right; it is fairly common knowledge that when you don't have to pay for a service, you tend to use it more freely; you also tend to value it less, ie, people often feel they "get what they pay for." The system doesn't work terribly well, but it works better than the alternatives. Now, the populists are threatening to make medical progress more uncertain than it already is; Reason remarks about the creeping governmental control over medical care and the hidden danger:
The level of freedom in research and medical commercialization matters greatly. It is a very large determinant of the speed with which future medicine arrives - and especially medical technologies capable of reversing age-related cellular damage that lies at the root of frailty, degeneration and death. At the moment, right this instant, the system is broken. The very fact that we have "a system" is a breakage; that entrepreneurs are held back from investment by rules and political whims that are now held to be of greater importance than any number of lives. That decisions about your health and ability to obtain medicine are made in a centralized manner, by people with neither the incentives nor the ability to do well.
As is always the case, the greatest cost of socialism in medicine lies in what we do not see. It lies in the many billions of dollars presently not invested in medical research and development, or invested wastefully, because regulations - and the people behind them, supporting and manipulating a political system for their own short term gain - make it unprofitable to invest well. Investment is the fuel of progress, and it is driven away by self-interested political cartels.
A report today, Drug Ads: Kill the Messenger?, suggests that the bureaucratic desire to regulate may be indulged in the name of the consumer, with the primary outcome being damage to our future national health:
Yet when Congress reconvenes next month, Sen. Herb Kohl (D-Wisc.) is expected to file legislation to ban or severely limit ads for prescription drugs. In fact, Kohl - who's set to chair the Senate committee that oversees the Food and Drug Administration (FDA) budget - has gotten the Government Accountability Office (GAO) to produce a report on direct-to-consumer marketing of medicine.
Drug companies are an easy target. They make a great deal of money for their shareholders and management, drugs are part of almost every American's life in one way or another, and the cost of "newer and better" drugs is often extremely high. Yet when Senators talk about pressing the Drug companies to lower their prices and try to deny them the ability to market their wares (and I write this as someone who will not meet with Drug Reps; I prefer to get my information about medications from more neutral sources) they are threatening all of us.
Today's extremely expensive medicine is tomorrow's cheap cure. We should all encourage the drug companies to make fantastic amounts of money. The more incentive they have to find new and more effective medications, the better for all of us.
Few people would object to the fact that the first flat panel TVs were exorbitantly expensive and only available to the very rich. If we used regulatory process to hold the price of flat panel TVs to an artificially low value, none of us would have the option today of buying increasingly affordable flat panel TVs. Why should anyone think drugs would behave differently?
I treat people, and have friends and family, who would not be alive today if our Medical care was limited to what was available when I graduated Medical School in 1974. One of the greatest bounties of our technological prowess has been the life saving and life extending boon from our biotech industries, which prominently includes one of the Populist's favorite villains of the day, "Big Pharma." It would be nice if Senators Kohl and Kennedy were honest enough to tell the American people that we can have cheaper drugs and Universal health care only at the expense of medical progress. The idea that we can keep prices artificially low, extend unlimited benefits to everyone, and continue to reap new benefits at an accelerating pace from Medical science is yet another quasi-Utopian fantasy that derives from politicians' aversion to making difficult choices. We can only have one of the three options and I am selfish enough to hope that the option we choose is the one most likely to enable most of us to live long and healthy lives, even if the very wealthy will have access to new and revolutionary types of care before it is available to me.
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