The Necessary Choice Between Evils

I completely agree with superwoman that there is no "free lunch" in healthcare; that is, that every service has an intrinsic value and thus an intrinsic cost. I feel that Americans, with our conflicted sense of capitalism, have the paradoxical tendency to not only criticize "for-profit" insurers or providers for changing too much for too many unnecessary services, but also for attempting to contain costs by cutting those services (for instance, by setting up managed care programs). There seems to be no winning for these people--if they increase prices, the public is upset because high costs inhibit universal access. But if they turn around and try to decrease costs instead, the public is still upset because cost containment limits individual choice.

The problem is that we want everything. If you put together every goal that American healthcare reform has ever touted in the past several decades, the final product that we are all working towards would look something like this:

Comprehensive healthcare services (including catastrophic coverage) available to all US citizens regardless of health status or income level, with little or no share of cost, accessible at any time, with little or no wait, performed in compliance with the highest quality standards, and with no limits on provider choice or utilization.

Is there anyone on the planet who doesn't want this? I want this. I want this in the same way that I want there to be a limitless source of clean and renewable energy that costs nothing to generate. I want this in the same way that I want there to be infinite tracts of farmland on which to grow crops year-round without using water, soil, or pesticides, and from which food can be distributed instantaneously to every person on Earth at no charge.

But while we can all agree that an infinite supply of energy and an infinite supply of food are both absurd notions, I think there's some hesitation to admit that an infinite supply of healthcare is equally impossible and absurd.

I've seen Sicko before, and it seems to imply that other countries (most of them socialist) have achieved the ultimate healthcare dream: limitless, universal, comprehensive, affordable care. But they have not. Like many of the people who've posted here, I've lived in England and heard many stories about people forced to delay care due to extreme wait times. I've talked to doctors in the UK about the enormous administrative burdens due to government bureaucracy. But the point here is not that they have failed to create a better healthcare system than ours, or that their problems are just as bad, if only different, or that we are all at fault because none of our healthcare systems are up to scratch in the final analysis.

The point is that none of our healthcare systems will ever be up to scratch--not if we're trying to create the kind of perfect (and therefore absurd) product I described earlier. Healthcare services will always cost something because someone has to manufacture the equipment, build and maintain the hospitals, create and distribute the drugs, make the diagnoses, and render the treatments. This means that someone else must always be paying it. When someone walks into a Swedish hospital and gets "free" care, the care isn't free at all: the person is simply paying higher taxes in exchange for a $0 co-payment. Healthcare is not free, and can never be free, because resources are finite. The question posed in healthcare reform shouldn't be, "how can we produce free and unlimited healthcare?" but "how can we best organize our payment and service structures to make do with what we have?"

What that means is that, however unwilling we may be, we must choose between evils--do we want people to pay only for what they need, or do we want to pool risk and force people to pay for what others need? Do we want more choices or higher cost? Are we willing to take on a single-payer system in exchange for longer wait times? And so on.

Sicko gives the impression that America is morally handicapped because we have made some of these evil choices and other countries have not. I think it's closer to the truth to say that we have made some of these evil choices, but unfortunately, we have not made them as well as some other countries have done. But to say such choices are unnecessary is not only false but also dangerous; it undermines health reform instead of advancing it.