Tuesday, March 30, 2010

Basic Civics Lesson - Healthcare Supply & Demand

This is a basic civics lesson. Not fully explained, not completely elaborated. It is, obviously, on the subject of the new healthcare legislation.

I don't support forcing insurance companies to accept any and all comers and pay for all things. Insurance is based on the concept of paying in along the way to get the benefit when you need it. The companies, if required to pay out in excess of what is paid in, will go out of business. They refuse people with pre-existing medical conditions in most cases - except that some will accept them with significantly increased rates - because those people aren't taking it on a "if they need it in the future" basis. They're going to pay in less than the benefit they get and the insurance company will make no money on their policies. Follow that to its logical conclusion, when you force the companies to pay out continually more than they take in, and you find the companies going bankrupt. Those people lose their coverage unless the government takes over the entire thing, either paying out and covering all medical expenses (and going bankrupt as they pay the demanded rates) or taking over the providing of healthcare itself.

Completely aside from the inefficiency of government compared to private industry, that leads to a motivation problem. Like it or not, there are certain basic truths we have to accept. Healthcare is subject to the laws of supply and demand. There are only so many healthcare professionals to provide care to those seeking it. There's been a shortage of healthcare professionals for years compared to the number of people seeking care. I've heard many arguments about how "doctors are paid too much anyway." That argument completely ignores the fact that the money is a significant motivator for people who go into the medical field. If 20% fewer people decide to go into the medical field, our healthcare shortage gets even worse. And, like it or not, numbers matter. No matter how passionate the doctors out there are, if there aren't enough of them to keep up with the demand then we can't provide adequate healthcare.

Even among doctors who don't go to med school just for the money, med school is expensive. By the time they get through undergrad, go through med school, do residency, get certified (assuming they don't do a specialty, which takes even longer) unless they come from a family that could afford to pay for all of that, they'll be in loads of debt. Probably 30k or more a year in tuition & school costs, 20k or more a year in cost of living(and that's assuming they live in areas with such a low cost of living, NY, CA and other more expensive areas are even worse) all in debt. About 50k a year. For about 10-12 years, most likely. They'll be half a million or more in debt, most likely. Most people, when faced with that kind of debt in order to pursue a career, will choose a different career path if you start telling them they'll only make 40k, 50k, 80k a year, are gonna seriously rethink their career choices.

Not all doctors make the big money, though. The big money is generally paid in big hospitals or boutique medical facilities. General practitioners, family practitioners, local doctors don't make nearly that much money. They also see fewer patients. Hospitals are flooded with patients and their doctors have a never-ending supply of patients demanding their time and attention. They work long, arduous hours, with few days off and in a high pressure environment always worried that if they make a single mistake, the patient will try and take them for everything they have. I knew a doctor who worked at a hospital. He had one day off a week. He worked 12 or more hours a day - many times, he'd work straight through for days in a row, living on coffee and hospital food. He didn't even bother renting an apartment. He showered at the hospital, slept on a couch or a cot in the break room and wore scrubs all the time. He made a very good salary but he worked his butt off and had no life.

If you want someone to be willing to take a job that demanding, which consumes that much of their life, you'd better be willing to compensate them.

No, this government healthcare program is not a good idea. It will not serve any public good. If everyone had insurance, they'd have better access since private doctors wouldn't refuse them as often. But they don't. And you can't force everyone to buy insurance. Nor can you force the people who are working and making money to pay for the people who don't. I've been one of the people who can't afford insurance because I didn't make enough money. I had to choose between having a place to sleep or having insurance. I chose to have a place to sleep. I chose to spend my income on my day to day necessities, counting on the fact that I was a healthy young adult, less likely to need expensive medical care. That was not the best scenario but it was a choice I made. If I had gotten hurt or ill, I'd have had to pay out of pocket. But just because I didn't buy insurance doesn't mean YOU should have to pay for me to get treatment. That was my choice and I accepted the consequences of it.

It's called freedom of choice. Freedom of choice is meaningless without the freedom to take the consequences of your choice. If the government is going to pay for everyone to be taken care of, the government will go bankrupt as long as we live in a system based on some form of money exchange. Unless we do away with money and just pay people through distribution of resources. Won't work, since money is the basis of the GLOBAL economy. Further, that gives the power to distribute resources to the government. Which also means that the government has the power to deny resources or take them away. It's the same principle with our rights. Our rights don't come from the government, the presumption is that we already have rights unless they are limited by legislative action. That's why our laws and system is a proscriptive, not a prescriptive, one. We don't tell people what they are allowed to do, we tell them what they are not allowed to do. And try to only do that when it is something which causes harm either to another individual or to the public as a whole.

Our government wasn't designed to provide for the public good. It was merely designed to prevent public harm.

This is your basic civics lesson for today.

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