Thursday, November 22, 2012

The Cost of Health Care

I covered a lot of my thoughts about the way in which capitalism structures the health care industry, both materially and ideologically (see my health series). This discussion follows fairly directly from those ideas.

Partly this is spurred by a recent experience I had, in which someone I knew was being kept alive on a ventilator, although it was against both their own wishes as expressed in the advance directive and the wishes of their spouse. I was reminded of the fact that more than a quarter of the total health care costs in the U.S. are spent on people in the last stage of their lives.

Indeed, the U.S. has one of the most expensive (especially in comparison to quality) health care systems in the world. The unjustified costs stem largely from the attitudes I discussed in my previous posts: 1) the assumption that the causes of ill health are material/individual and always require material interventions; 2) the obsession with "normality" and the treatment of variable states as "deviance"; 3) and the aversion/inability to cope with death and irrational belief that prolonging life is desirable.

1. When people feel a little different than usual, they go right to the doctor. Even colds are not considered as things that occur from time to time (like bad weather) and pass with time and rest. Some intervention must take place.

2. At the doctor, people only feel satisfied with the visit if they have a diagnosis and a prescription. Compounding the problem, doctors often are paid according to the number of people they can see everyday, thus encouraging them to breeze through each visit, barely listening, slapping together a diagnosis, and writing off a prescription. [I already discussed my frustration with the over-prescription of antibiotics - not only is it costly, but it weakens immune systems and promotes the rise of antibiotic resistant bacteria.]

3. People believe that health care providers are capable of solving every problem and should theoretically be infallible. Doctors and hospitals are always under threat of law suits. This, of course, directly raises the costs of health care; it also indirectly increases costs because doctors feel compelled to order millions of tests - many of them costly and unnecessary - to cover their butts, and may also be induced to expend resources wastefully to comply with families' demands (like keeping someone on a ventilator when they are going to die in a few days anyway). This point, in particular, is attributed responsibility for a lot of the cost inefficiencies in the U.S. health care system compared to other health care systems.

The upshot of all of this can be characterized by a libertarian maxim: people want a lot more than what they are willing to pay for. They want all of the medical interventions possible, but have constructed a system that is not able to absorb all of the costs. What happens, of course, is that all the people with insurance and means to afford out-of-pocket costs who demand unnecessary tests and treatments, and thereby drive up the costs of care, make it that more difficult for people in poverty to afford the care that IS necessary for them. Once again, it is the poor who are subsidizing the extravagance and irresponsible behavior of the well-to-do.

No comments:

Post a Comment