Princeton health economics Professor, in the Health Affairs blog, discusses what he learned during last week's health care reform debate. The renowned health economist divides the Americans into two classes -- the policy-making elite and the "plebs." Below is what Professor Reinhardt concludes:
To the policy-making elite:
The view from the left. In the ideal world envisaged by the policy-making elite left of center of the ideological spectrum, the individual’s health care experience is independent of that individual’s socio-economic class, and the individual’s financial contribution to pay for health care is based on that individual’s ability to pay and completely divorced from that individual’s health status. Access to needed and locally available health care is viewed as an individual’s inherent right. This dream makes the financing of health care in the country a collective responsibility in which relatively healthier and/or wealthier people subsidize the health care used by relatively sicker and/or poorer members of society. Rationing health care by income class has no place in this picture. Heavy government involvement to enforce the implied redistribution of income does.
The view from the right. By contrast, the policy-making elite right of center of the ideological spectrum dreams of a world in which the individual’s use of health care is, in the first place, his or her own financial responsibility, although some collectively financed subsidies should be granted low-income families to help them afford at least a bare-bones, minimal package of health-care services. In this view, it is not only acceptable but entirely proper that sicker individuals should be charged higher health insurance premiums than are charged healthier individuals. Furthermore, rationing a good part of health care by income class – especially primary and secondary care — is countenanced with equanimity, because health care is viewed as basically not different from other basic commodities, such as food, housing and clothing, whose quantity and quality also is rationed by income class. Access to needed health care is decidedly not viewed as an individual’s right. It is, at most, a privilege bestowed on the less fortunate by the more fortunate. Government’s role in health care in this vision is to be kept to a minimum.
When I say "rationing by income class" I mean the following. Textbooks in economics explain that the role of prices in an economy is to ration scarce resources among unlimited wants. If prices and high cost sharing by patients are used as instruments of cost control in health care, they will ration low-income families much more out of health care than they will high-income families – hence rationing by income class.
In other words, to the policy-making elite, there are irreconcilable philosphical differences between liberals and conservatives about how best to ration our nation's health care. Compromise ain't gonna happen anytime soon.
As for the American plebs:
In the meantime, as the policy-making elite stews in its stalemate, the American plebs dreams of a political Messiah willing to build for them a health system that:
- Lets only patients and their own physicians determine how to respond clinically to a given medical condition, never an insurance clerk or, even worse, government bureaucrats.
- Limits their families’ out-of-pocket payments for health care to make it "affordable."
- Keeps insurance premiums and taxes for health care low.
- Does not ever ration health care, because that is un-American and practiced only by un-American alien nations with inferior health systems.
- Does not allow public or private insurers to let "costs" or "cost-effectiveness" ever enter coverage decisions, because that would implicitly put a price on human life which, in America, unlike elsewhere in the world, is priceless.
- Does not mandate individuals to purchase health insurance, if they do not wish to do so, if for no other reason than that this would be unconstitutional and, therefore, un-American.
- On the other hand, grants every American the moral right – backed up by a government mandate called EMTALA– to receive critically needed and possibly high cost health care from hospitals and their affiliated doctors, even if they are uninsured and could not possibly pay for that expensive care with their own resources.
- Controls Medicare spending, which is widely thought to be completely out of control, as long as it does not reduce payments to hospitals or to doctors or to producers of medical technology, or to any other provider of health care.
- Provides universal health insurance coverage to all Americans, provided it does not mean raising taxes or cutting Medicare spending or raising premiums on healthy Americans.
- Keeps government out of health care but somehow makes sure that insurance companies do not exploit patients through incomprehensible fine print, no one engages in price gouging – e.g., charge $10 for an aspirin — and no one in health care earns excessive profits (or any at all).
That’s all.
We all look forward to that utopian moment.