Today’s health care debate in the popular press can be boiled down to the following few points:
- Health Care is too expensive and we need to make it more ‘affordable,’
- While reducing the price, we must maintain individual choice of which physicians they wish to see and which procedures they desire.
- Switching from a fee-for-service system to capitation or managed care system is undesirable.
- All people are entitled to the procedures using the latest medical technology.
Basically, we want the best health care in the world for cheap. Unfortunately, this is impossible. Robert Samuelson’s article in Thursday’s Washington Post (“The Fix-It Myth“) does a great job of detailing the tradeoffs inherent in treating the ill :
Here’s the paradox: A health care system that satisfies most of us as individuals may hurt us as a society. Let me offer myself as an example. All my doctors are in small practices. I like it that way. It seems to make for closer personal connections. But I’m always stunned by how many people they employ for nonmedical chores — appointments, recordkeeping, insurance collections. A bigger practice, though more impersonal, might be more efficient. Because insurance covers most of my medical bills, though, I don’t have any stake in switching.
On a grander scale, that’s our predicament. Americans generally want their health care system to do three things: (1) provide needed care to all people, regardless of income; (2) maintain our freedom to pick doctors and their freedom to recommend the best care for us; and (3) control costs. The trouble is that these laudable goals aren’t compatible. We can have any two of them, but not all three. Everyone can get care with complete choice — but costs will explode, because patients and doctors have no reason to control them. We can control costs but only by denying care or limiting choices.
Even in health care, you can’t get something for nothing.