“Costs are keeping patients from care.”
In today’s Boston Globe I read that “Costs are keeping patients from care.”
Think about it. I’m certain that you would never see headlines like the following: “costs are keeping drivers from cars,” or “costs are keeping buyers from houses.” So what’s the difference between buying medical care and, say, buying shelter or transportation, or clothes? Clothes do keep you warm in the winter. Cost shouldn’t be a factor in the one, but should be in the other?
It would seem that the reporters who report and write this way hold, perhaps not consciously, to the so-called Second Bill of Rights. Cass Sunstein in an otherwise excellent piece written for a collection of articles, “What We Do Now,” following what was for him and the other writers, the disastrous presidential election of 2004, had this to say:
“Roosevelt argued in his State of the Union address of 1944 that security means not only physical security, but also includes economic, social, and moral security. …[Roosevelt] had accepted a ‘second bill of rights.’ Such things as right to a good job, a decent home, health care, and education…. Government has a final responsibility for the well-being of its citizenship.“
Is the Globe reporter arguing that the people’s right to health care is being interfered with, is being blocked by the costs of such things as co-payments and deductibles? In any case, as she tells us, “state lawmakers have scheduled a hearing… [to consider] a proposal to allow residents with chronic illnesses to buy prescribed medications and medical devices without facing a co-payment or deductible.”
But the real issue behind all this is the skyrocketing cost of medical care. Food, clothing, and shelter costs are being kept more or less in line with ability to pay. Health Care costs are not. They now represent what, 15, 20% of the GNP? Co-payments and deductibles are just one, not unreasonable, attempt to meet some of these costs, to place some of the excessive cost burden on the person receiving the care.
What if the costs of transportation suddenly started to skyrocket? Would the Globe write about the costs keeping drivers from cars with the clear implication that driver subsidies were necessary? Perhaps, but that’s not what’s happening. Also, transportation is not yet included in the Second Bill of Rights.
As far back as 1994 a Cato Institute paper by Stan Liebowitz said, I think convincingly, that “the major culprit in the seemingly endless rise in health care costs is found to be the removal of the patient as a major participant in the financial and medical choices that are currently being made by others in the name of the patient.” The fact that transportation costs are still within reason may very well be attributed to the fact that the major participant in transportation choices is still the driver and owner.
The principal thrust of the Globe article is that the patient’s participation in “financial and medical choices” is keeping him from obtaining needed care. For his/her expenses are so high, in the form of co-payments, deductibles etc., that he/she decides not to pursue the visit, treatment, or drug purchase. Although the article doesn’t mention the fact that without this cost conscious behavior on the patient’s part health care costs would skyrocket even higher.
Health care is really all about the costs (as is most everything else —it’s just that these costs are rising much too rapidly). While we more and more seem to be able to pay for clean air and clean water, and by and large individuals do seem to be able to purchase in the way of food, clothing, transportation, and shelter what they need, more and more the costs of available medical treatments go well beyond the ability of most to pay for them.
Whereas cars still perform a simple function of getting us from here to there the myriad kinds of medical care become more complex, more and more difficult to enumerate, let alone pay for. And more important medicine promises things vital to our lives. And as a result it becomes harder and harder to separate, given what is promised and available, what we want from what we need, let alone from what we should have and in some mysterious manner deserve.
Health care really is a horse of a different color. Probably because without it people’s very lives are threatened. We can live simply and well in regard to most everything else. But health care promises to enable us to live well and longer. Furthermore, isn’t it the government that is supposed to protect its citizens? Well yes, but not perhaps if the costs of that protection cannot be met. At the moment we seem unable to meet these costs, and here’s the rub, we don’t know how to meet them.
Multiple payers as we have at present? This system is simply not working for everyone. A single payer system as in France or Canada? Apparently too costly. Too costly because of the medical treatments that are available, and that given the availability are not easily rationed, or given to some (the affluent) and not to others (the poor). All treatments given to all regardless of ability to pay would probably bankrupt the country.
Patients must to some important degree, just as now they decide what to buy in the way of cars, homes, and clothes, decide the care they can afford for themselves. Only those who could afford little of what we would define as essential care would be eligible for health care subsidies. Only in this way would the costs become manageable.
But as it is now our politicians would make health care comparable to that received by the members of Congress available to all. How would they pay for it? By tax revenues? Not possible. In regard to health care what people will demand as their “right” will always come at a greater cost than society can afford.
