KAP and Other Matters

I am very disappointed with American politicians and citizens involved in arguments about medical care and Social Security. Most of the bickering is deeply afactual, almost other-worldly. Opponents of the Democrat's health care reform proposals have invented policies no one advocates and even lied about relevant considerations. Proponents insist on talking about how reform will both lower medical care costs and raise the extent and quality of medical services (normally opposite goals). Scarcely anyone is willing to confront the essentials of medical care, although there is lots of discussion about what it costs.

Your Skin in the Game

All human beings are, by all reports, biological entities of the sort common on Gaia, our planet Earth. Possibly excepting a few ancient single cells, biological entities on this planet are born, live long enough to reproduce and die. Human beings have been smart enough to understand this condition for at least the last five millennia. Based on archaeological research into prehistoric burials and grave goods, it is likely the basic facts of life and death were known to our most ancient ancestors over thirty millennia ago. These facts happen to underlie the current political jousting over medical care, even though they are seldom mentioned.

 Given human physiology, people will get sick, so have medical needs. This is not a condition subject to choice; i.e., one does not decide to have the flu, cancer or AIDS. Disease, disability and death are unavoidable universal conditions of life. People can chose to accept whatever comes along, or they can attempt to fix the condition; that is the only choice they have.

Very few people resign themselves to whatever fate diseases portend, even if there is no established cure for what ails you. Since ancient times unscrupulous people have taken advantage of those grasping for straws and gasping for their next breath. One of the classic figures in the American Wild West of yore was the Snake Oil Salesman. The Wild West may be gone, but the patent medicine wagons are still with us on TV and "health" stores. What the persistence of gigantic alternative medicine and health foods industries proves is that people are not "rational" about their physiological problems. (Here, I assume practices based on Western medical science are "rational.")

Economic Assumptions

The foregoing facts undermine Capitalist analysis of medical care.

In neo-classical economics, it is assumed there is always a market clearing price, whether positive or negative (Efficient Market Theory). It is assumed that a sufficient offer will bring about satisfaction of desire (Say's Law). It is assumed market players will make "rational" decisions or that whatever price is settled in the market is "rational." ("Rational" is a very slippery term.) All of these premises are challenged by modern research  (e.g.; Behavioral Economics) into actual market behavior.

Patients are frequently irrational about their medical care, especially if the disease process impairs normal brain function. Those who have to be sedated during treatment are obviously not in a position to make decisions. In most cases, patients have little or no knowledge of their condition or what treatments work. For this last reason, shamans have held important roles in human societies since prehistoric times.

There are thousands of ailments for which there is no known effective treatment. Despite spending more than a trillion dollars on cancer research and treatment over the last four decades, cancers are still not entirely preventable or treatable. The mere application of resources does not call forth solutions to medical problems.

Suffering people do not consider opportunity costs or alternative resource uses in their need. Although insurance companies have employed armies of actuaries and accountants to determine the economic value of human life and various disabilities, and Courts have awarded huge sums to plaintiffs claiming loss or mistreatment, no one has determined a generally accepted value for those things. Such institutional determinations are always after the fact, not factors and values considered by the patient in immediate need. In other words, the patient on the gurney doesn't negotiate with the attendants and doctors about the cost of care, if only because the patient cannot walk out if the price is not right. The ER, especially, is inherently uncompetitive.

In short, medical care is like food and water: you either have it or you don't. For biological entities, the cost of starvation, thirst and disease is incalculable.

The clear implication of the facts of our biology is that we can only plan and prepare as best we can to meet our needs. I don't think primordial bacteria ever asked for an economic evaluation of their continued existence,  nor should we. [Had our ancestors done so, probably we would not be here.]

Therefore ...

Most of the hyperbole about "health care" blowing past our ears lately is irrelevant. Even the complaints about excessive costs and going broke are beside the point. It makes no difference if we want our cancer cured, but have no methods or doctors to cure it.

The central question is how far are we willing to go in treating people's complaints? In answering this question, we must consider provision of the basic necessities of life, such as food and water, as well as medicine, clinics and hospitals. We must also take into account the education and assignment of people to the life support workforce.

In our society, medical care is an extremely complex activity. Decisions do not come down to so much money. The so-called free market does not and cannot solve the resource allocation problem underlying medical care. States which have workable medical care systems acceptable to their citizens have achieved their results from the top down; i.e., undemocratically. In such systems, there are always trade-offs (i.e., triage and rationing) which are decided by those in charge.

I believe the nature of the problem demands the kind of bureaucratic and technocratic solutions implemented elsewhere, in places like Europe and Canada.

Posted 10/16/2009 11:54:27 AM                Last update: 10/16/2009        Originated: 2/10/2009

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