The Health Care Question No One Dares to Ask

by futurist Richard Worzel, C.F.A.

All developed nations are struggling with health care because of their aging populations. In America, for instance, the Great Debate is on, chock full of noise and nonsense, about providing universal health care. Those opposed say that it is socialized medicine, and therefore a sin, and bad. Those who are for it say health care is a human right, and therefore a virtue, and good. And I can’t (or won’t) resist adding a couple of asides:

First, health care is not a human right. Tommy Jefferson and Co. never murmured a syllable about it, and would, I suspect, have been flabbergasted that someone would even suggest that government should pay for it. Likewise, the canard about socialized medicine is hypocritical nonsense as America has, today, the worst, least effective, most expensive kind of socialized medicine in the world. Medicare and Medicaid cover the two most expensive groups of the population: the old, and the poor, while leaving out the young, the middle class, and the healthy, all of whom would lower the costs per person of health care. And many of those who do not have health care coverage because they fall through the cracks (some 40 million-odd Americans) will go to the local hospital emergency room. Emergency rooms must, by law, treat walk-ins, even when the hospitals know they won’t be paid for such treatment, thereby throwing the burden on those who do pay. Since hospital emergency room care is the most expensive, and least effective, form of continuing health care imaginable, I submit that America has a hybrid system that costs more, and does less than universal health care would cost in its place. (Depending, of course, on how much pork is larded into final legistlation).

On the other side, Canada has universal health care, without a parallel private system – at least in theory – so that people stand in line, and if you die before you get to the front of the line, too bad. (Why this is worse than dying because you can’t pay has never been explained by the American right. Moreover, Canada really does have a parallel, private system: you fly to the America and pay to get treated there. No one wants to acknowledge this officially; it’s Canada’s dirty little health care secret.)

Britain has a hybrid system, with public health care available to all that is frequently dreadful, and occasionally pretty good, but with a parallel private system that anyone can use if they’re willing to pay. Of course, the private system bleeds resources that would otherwise go to make the public system better, so there’s a cost to both the private payers, and to the overall health of the nation. France has an excellent system, where patients co-pay 20% of the cost of treatment, but all patients generally get prompt, top-notch care, including home visits if necessary. The only downside is that this system is threatening to bankrupt the national government of France. And other nations have other systems that work to greater or lesser extents, but no one is interested in cataloging what works and what doesn’t anywhere else, since that would mean putting aside the ideology wars that dominate health care debates. (I’ve only listed the systems of which I have direct knowledge through personal experience with friends and relatives.)

Yet, the world is getting older, and my calculations show, based on such data as I can find, that health care costs in developed countries stay reasonably stable, on average, until around age 55, at which point they start to go up almost exponentially as aging bodies need more and more care. Post–war generations (notably the baby boom in those countries that had one) are now entering their early 60s at the leading edge, which means that the number of people needing ever-rising amounts of health care is going to place enormous strains on the health care systems of all developed nations, regardless of how they decide to pay – or not to pay – for it. Public or private, it doesn’t matter, health care is threatening to break the bank everywhere.

Which leads me to the one question that everyone wants answered, and nobody wants to been seen to ask: How can I get someone else to pay for my health care? Everyone wants the finest possible health care, no matter what it costs, and everyone wants to duck out on the bill. This is particularly true of those who are reaching the Danger Zone of 55 and up – we want to find a way of forcing the rest of the population (which means the young) to pay for the health care we know we will need. Which, by the way, is blatantly unfair and unreasonable of us, especially as we have systematically ducked all responsibility for laying resources aside for that purpose in order to keep our incomes and spending artificially high. Now we want our children and grandchildren to pay for our fun.

So the real, underlying problem of health care in a world of aging people is that everyone wants to shove the costs off on someone else. Since that’s not possible, in aggregate, we get all the creative fairy tales dressed up as politics that are going on, with truly nonsensical arguments used to create enough furor to distract us from the real question.

Avoiding this question is not a win-lose issue; it’s a lose-lose issue, one that will bankrupt our governments and harm us all if we don’t soon start speaking the truth, to ourselves and to each other. As long as we duck this question, we will be dealing in smoke and mirrors, and not grappling with the real issues.

But if we do start truth-telling, then we can start asking other, relevant questions, like: Ignoring ideologies, and based only on empirical evidence, what’s the most cost-effective way to run a health care system? What works best in other jurisdictions, and how can we adopt it here? How do we attract health care workers without spending our entire budget on their services alone? How do we structure an insurance system that spreads the risk within an age group, while not unduly penalizing the young? How do we encourage the development of new drugs without bankrupting payers? What’s a fair share of health care cost per individual, and how should we measure it? Are we going to distort the premiums to benefit politically powerful groups, or use statistics to determine health insurance costs? If the latter, should we give price breaks to those who lead healthy lifestyles and penalize those who are couch potatoes do eat junk food? And how do we deal with the inevitable groups that want to distort the system? For instance, if we decided to penalize those who eat junk food for the (documented) higher costs of their health care, then the entire fast food industry would lobby against the proposal, but quietly, and behind closed doors. So, how do we prevent his from happening?

None of these questions are easy. It would be far easier to duck behind the current smokescreens of public-vs-private care and ideological purity. But if we do that, we will all of us suffer because of it.

I think the time has finally come for honesty, because the consequences of lying to ourselves will be devastating.

© Copyright, IF Research, June 2009.