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The design of any health care system revolves around the ethics of the people creating it. The ethical questions lay the groundwork for the entire system.
Consider this question. Professor Reinhardt proposed the question, If the child of a rich American family and the child of a poor American family both contract the same illness, should both children have the same chance at being cured?
All other developed nations have said yes to this question. And, over 85% of Americans agree with it. Still, there is some opposition.
An article in an American Medical Association journal answered the question like this. The correct answer is no. To provide health care for the poor child, other Americans would have to be taxed for care. That would generate heated and costly political battles. To open the doors to forced redistribution induces the rich to spend more defending their wealth, and the poor to spend more to take it away. Both sides cannot win, and a smaller pie leads to worse health care.
In other words, do people have a right to life? Or, is it just another commodity you buy? Most people like the idea of coverage for everyone. Why? Well, it feels like the right thing. If you had a cure for someone, would you feel right about letting them die because they didn’t have enough money? Most good people would readily give the cure away. It’s the right thing to do.
Good health can only come about if the system is designed to bring about ethical behavior. A for profit system gives insurance companies the incentive to deny treatment. In fact, they deny about 30% of claims. Insurers try to avoid people that are sick by dropping them and helping those that are profitable; that need care the least.
Do you want a system that rewards doctors and hospitals for patients being in good health? It seems obvious, but the United States has a perverse method of incentives. Actuaries of insurance companies spend time figuring out these issues. The only problem is that their goals are to maximize the benefit of the insurance companies, not the individuals. This is primarily why actuaries in the United States do not want preventative medicine. While it pays for society, it doesn’t pay the insurance company next quarter.
Many other developed countries live longer than United States citizens. One important reason, is due to the doctor caring and the society working hard at preventative care. The adage, an ounce of prevention is worth more than a pound of cure is totally true.
Doctors in England are given bonuses for how healthy they keep their patients. You can find billboards everywhere reminding you to be healthy and get regular checkups. Nurses even knock on doors to see if they can help you with preventative care. This is in stark contrast to the American way of denying preventative care on grounds it isn’t profitable enough.
Suppose you had the question posed to you. Would you rather make 200k per year and deny patients that need care or would you rather make 150k per year and do whatever you need to help them. Most physicians that got into the field for the right reasons would much rather work in a system that works well. They feel a sense of pride for the good health they are bringing to the community. Do we really want doctors and nurses that hate it and are only in it for the money? Doctors in other developed nations are happy with their jobs. While they might feel attracted to making more money in America, they don’t want to come here and practice in a broken to come here and practice in a broken system even if it means more money to them.
Patients can’t rationally purchase health care. How can anyone achieve value for their money?
Suppose a blind man was buying lollipops that all have the exact same flavor. He picks one out that costs $10.00 when he could have got the same thing for $.50. He might ask the cashier for some advice on which one to pick. If it worked like health care, the cashier would simply say, “I don’t know. If you want a lollipop, you have to pick one. Good luck!”
Of course, health insurance companies are for transparency. The American Hospitals Association lobbies congress for price transparency for hospitals. Senator Grassley from Iowa is recently working on a bill to increase price transparency for insurance companies. The truth is this. NOBODY IS WORKING ON PRICE TRANSPARENCY FOR THE CONSUMER. And yet, almost all Americans are in favor of price transparency.
The basis of any good health care system is good ethics. The ethics must align with the interests of the producers of the care. The United States health care system allows for perverse incentives that reward denial of care for those that need it most.