The Great Lie in the U.S. Health Care Debate

I want to talk about something a little different today. If you're an American with bad knees, yes, it affects you – but it also touches the lives of many millions more than than that.

I want to talk about the great lie in the debate about U.S. health care.

First, this isn’t about Democrats, Republicans, Democans, Republicrats, whatever. Personally, I’m an Independent. I think both parties have become corrupted by money, but that’s a subject for another day, and another blog.

The great risible lie is this: U.S. health care is a free market that people choose or choose not to be part of, and like other free markets, the solution to our current woes – millions of uninsured, soaring drug prices, unaffordable insurance, etc. – can be found simply by unshackling market forces.

This is ludicrous.

Look, if I walk into a Honda dealership, and demand an Accord for free, the salesman (if he’s not laughing too hard) will point me to the door and tell me to get lost.

Sales of autos operate well within the free market model. There are competing dealerships; comparison-shopping isn’t hard to do; a Honda Accord buyer who doesn’t find the deal he wants can substitute a like product (a secondhand Accord, or another model from a different carmaker) to satisfy his need for private transportation. Also, we all agree no one has a “right” to a car.

But if I walk into a hospital emergency room, staggering and vomiting blood and without a penny to my name, the nurse on duty won’t point me to the door and tell me to get lost. That hospital has a legal obligation under the Emergency Medical and Treatment Labor Act (passed by Congress in 1986) to care for me. If I don’t have insurance, it doesn’t matter. What’s more, the law doesn’t let doctors half-treat me or dump me on another hospital for failure to pay.

And, at some point, most everyone will wind up in an emergency room. It happens, even to people who eat their kale every day and exercise vigorously and do a hundred other things right. We’re all going to need a health care “product” at some point – and we’ll need it for much more than emergency room visits -- whether we can pay or not. If we can’t pay, everyone else gets to pay for us that day when we land in the ER (see Note #6 below).

The alternative is stark: All those people without insurance, and without a means to pay, we let die.

Who wants that? Who thinks that even makes sense in the richest nation on earth, which spends so much on health care?

I know there are a lot of ideas on fixing the U.S. health care system: offering insurance across state lines (which will do very little), tort reform (which will do a little, but not nearly enough). But the first thing we have to face: every American is in this system together. We need a proposal that starts with that as the first principle. Everyone gets covered. Maybe that leads to single payer. Maybe that leads to Medicare for all. Or maybe there’s a different way.

But let’s be honest about who’s in the U.S. health care system.

We all are.

Some additional notes:

1. The U.S. pays two to three times as much per person as most other industrialized countries on health care. Despite this, the quality of our health care is ranked only 28th worldwide, below Slovenia’s. The U.K., which is ranked fifth, spends less than half what we do per capita. So it’s like we order filet mignon at Le Cirque, and in return get a turdburger in a styrofoam clamshell. Why isn’t everyone incensed about this? This isn’t a Republican issue, or a Democrat issue. It’s a people-opposed-to-stupid-spending issue.

2. On free-market “comparison shopping” for medical services: It’s practically impossible. Don’t believe me? Read this. The author says he should have been the perfect shopper for medical care: (1) he lives in Massachusetts, a state that passed price transparency laws to help patients shop for care (2) he’s a physician (3) the surgery at issue was minor and not urgent, giving him plenty of time to shop around (4) his research focuses on consumerism and price transparency. So it’s like the author of the Kelley Blue Book shopping for a used car. And how did the process go? Terribly. How’s this an efficient free market when price discovery is a nightmare?

3. Did you hear the story about Fin Mox? It’s an antibiotic for fish. But people were buying it for their loved ones – er, loved “fish” – because they couldn’t afford regular antibiotics. I’d link you to the Amazon page, with the hilarious comments from people whose “fish” didn’t have health insurance, and for whom Fin Mox was a blessing – but Amazon took the page down. The richest country in the world has poor people buying antibiotics for fish to get the medicine they need? That’s a disgrace.

4. Read this from emergency room physician Farzon Nahvi. He treated people – including a man with a brain bleed, whose life he saved – who later said, “Thanks, but I wish you hadn’t done that.” Because they didn’t have the money to pay the staggering emergency-room bills. Nahvi quotes Paul Ryan on health care: “You get it if you want it. That’s freedom.” Nahvi observes “Being given services without your consent, and then getting saddled with the cost, is nothing like freedom.” No, and let me complete the thought: it becomes closer to indentured servitude – or actually slavery, since indentured servants at least have to sign a contract.

5. One thing that puzzles me: if you believe in a free market in labor, you should definitely hate the current health care system. A full 56 percent of Americans get their health care through their employer. Many people are shackled to jobs at large companies, resistant to changing, because they don’t want to lose that precious insurance benefit. So think of all the people who could be innovators, or who could switch to a more productive job at a smaller company, benefiting the economy, but don’t because they need their gold-plated health insurance plan. So we squander the potential in our labor force. Why aren’t more conservatives upset about this?

6. A report last year showed one of five Americans visit the emergency room at least once a year. Separately, a study showed that a whopping 71 percent of these visits were either unnecessary or avoidable. Emergency room care is very expensive treatment, so this indicates a lot of waste. People lacking health insurance sometimes wind up in an emergency room because they can’t afford regular doctors.