By Joseph Jarvis
For the Deseret News
Published: October 6, 2018 5:00 pm
The Deseret News failed to capture the magnitude of U.S. government involvement in health care (In our opinion: Time to tackle government-supplied health care before it gets unmanagable, Sept. 24). In addition to 122 million on Medicare, Medicaid and military health plans, there are millions more on CHIP, state and local government employee and federal employee plans.
Add to that the additional millions who receive VA health care and Obamacare subsidies and the total approaches 200 million Americans with some form of government health care. In addition, remember that private employer health plans exist because of a massive federal tax credit that has propped them up since World War II. No wonder that most of the money flowing into U.S. health care delivery is from taxes. Americans pay the world’s highest health care tax burden. Without public money, there would be no American health care.
This is the health care system that we have chosen for 75 years; we need to stop pretending that somehow we could now choose to have health care without government involvement. We also need to stop pretending that market forces and competition will improve American health care delivery. None of the prerequisites of market economics holds true for health care. Patients are not shoppers because they lack clinical knowledge (no caveat emptor) and are sick and injured, therefore not free to decide whether, where and what clinical services are needed. Sellers of health services are not supposed to act in their own self interest, but should put the patients’ needs first. Positive externality refers to a situation when someone other than the buyer or seller in a market has a legitimate interest in the outcome of a transaction, such as is the case when the general public has an interest in assuring the best care for a patient with a communicable disease. We have massive infusions of tax dollars into health systems because of positive externalities.
Finally, the inverse relationship between price and demand does not hold for health services. No one ever bought an appendectomy because it was on sale. And no diabetic willingly forgoes insulin even if the price skyrockets. Demand for health services is determined by epidemiology, not price. Health care is not a market commodity; the invisible hand of Adam Smith will never save us from our health care woes.
I agree with the Deseret News, Congress has abysmally failed us on health care. Hyperpartisanship is part of the problem, but the massive campaign donations and lobbying power of the medical industrial complex assures that both parties defend business as usual in health care delivery. Cost is our principle health care problem. All of the federal debt now and on into the future is due to unfunded health care costs. We have high cost because the health insurance business model is incredibly inefficient (wasting up to $500 billion per year) and U.S. health care is poor in quality (wasting up to $700 billion per year). We don’t need more money in American health care, we need to reduce the inefficiency and quality waste inherent in U.S. health care business as usual.
Congress might be able to agree to allow states to attempt sustainable health system reform. Seven Democrats have co-sponsored a bill, the State-Based Universal Health Care Act, that would strengthen the power of states to reform health care systems and even allow neighboring states to band together to achieve better regional health care delivery. I believe many Republicans would agree that state based health system reform is a logical step in our constitutional form of government.
I urge all voters to carefully inquire of their congressional candidates whether they will seek enactment of the State-Based Universal Health Care Act.
Joseph Q. Jarvis is a public health physician. He is the author of the recently released book “The Purple World: Healing the Harm in American Health Care.”