The Politics of Health Care
By Dr. Lon Jones, D.O.

Common Sense Medicine^© looks at the politics of health care.

If a function of government is to “promote the general Welfare,” as our Constitution implies, we aren’t doing too well. The Institute of Medicine, the body of learned scholars given the job by Congress to improve our health care, states that our system kills thousands of people every year and that improvement is desperately needed, but they have no specific suggestions other than using more computers. Maybe part of the problem is that they are all learned scholars; they all come from centers of medical academia. That great American poet Wendell Berry said, “If you’re looking for answers don’t go to the temples. It’s the desert that gave us the prophets, not the temples.” People in the temples have a vested interest in maintaining them, not in risking their destruction by some new ideas.

So if the Institute of Medicine is not likely to improve our health care can we at least look to politicians to make it more equitable and affordable? Not if the recent Medicare bill, that gives far more to the system than it does to the people, is any example. Paul Plsek, writing in Crossing the Quality Chasm, explains how our health care system is a “complex-adaptive system” with a great ability to adapt to environmental stimuli. He points out that all of the political efforts to control the costs of health care have failed. The health care system just adapted to the constraints and grew in different areas. But repeated failures don’t stop the politicians, especially when they can appeal to the voters that they did something.

So the Democrats argue for a single payer system that would save by being more efficient, without mentioning that this would be controlled by the government. Such endeavors have failed in the past because of the fear of socialized medicine and the problems of lines, waiting, and poorer service that are perceived to accompany it.

The Republicans, on the other hand, argue that salvation lies in privatization. Newt Gingrich, one time Speaker of the House and now a leading Republican policy planner at the American Enterprise Institute, wrote that shifting away from “the failed bureaucratic third-party-payer model” back to a “market-mediated binary-payer model” would be “the single most significant reform that can be made in saving the country from sky-rocketing health costs.” (Gingrich, Newt. Quoted in Christian Science Monitor 9 Dec 2003 “Bush signature won’t end Medicare debate,” by Peter Grier)  I had to read this twice before I realized that Gingrich was advocating that we do away with health insurance, ‘the failed bureaucratic third-party-payer model,’ and go back to paying for health care out of our pockets, ‘the market mediated binary-payer-model.’

Both sides, as usual, have their heads in the wrong places. The Democrats single-party-payer, the government, would not address the moral hazard that makes third-party-payer systems so expensive; why, in Gingrich’s words, it is a “failed” system. Moral hazard relates to the fact that if someone else, the third-party, was paying for your car we would all want Cadillacs, and that we would not save nor expect to pay full price for this luxury. The Republicans would throw out the baby with the bath-water. Despite its expense, health insurance is far from being a “failed” system. It has provided a safety net for millions of Americans that would have been hard pressed to pay for catastrophic health problems on a “binary-payer” model. Somewhere in the middle of these two extremes is a sane middle ground that recognizes both the problems inherent with third-party systems—the moral hazard—and those associated with privatization, where the need to make a profit all to often  overrides the development and use of less expensive preventive therapies.