Health Care, Part 3: The Best of Everything

Everyone cannot have the best health care. No matter how much some may wish otherwise, it is impossible by definition. For “the best” of a thing to exist, there must necessarily be “the worst” of that thing, with a continuum of relative goodness in between. Some would argue that this fact of life is unfair, and that we as a society should collectively correct it. Why should Mr. Rich have better health care than Ms. Average or Mr. Poor? After all, if health care is a basic human right, and we all have equal rights, then we should all get equal healthcare, right?

Let’s examine this argument. If our goal is to make sure that each person the same quality of health care as everyone else, then by definition we will all end up with a level of care that is somewhere on the line between “worst” and “best”. Sounds good, you say? Let’s assume for the moment that we could actually pull this off(We can’t). Let’s pretend that our lawmakers are perfect and incorruptible (They’re not). Let’s pretend that people will still work just as hard to create new drugs and innovative treatments even after their economic incentive is removed (They won’t). Let’s assume, for the sake of argument, that a logistical system could be put in place that would be streamlined, efficient, and free from bloated government bureaucracy (Yeah, right!). In this wonderful imaginary world, when we finally achieve our goal of equal health care for all, the end result would be healthcare quality that is precisely average. That’s not an opinion, it’s a mathematical fact.

Okay, so maybe you think that’s better than what we have now. If you believe forcing everyone to have average healthcare quality is the fair and just way to do things, there is still a basic flaw in this system. The central problem is that someone has to decide how good “good enough” is. In a market system, this happens by millions of individuals making daily decisions about their own needs, based on their own unique situation. Some call this greed, others call it self-interest; either way, it is widely distributed. In a controlled system, the answer to the question “how good is good enough?” must be an arbitrary one. Someone, or some group, must make that determination. Even in pretendland, where perfect and benevolent politicians exist, the question of fairness and morality comes into play as freedom and control is taken from the individual and placed in the hands of someone else.

Now let’s put this Peter Pan scenario back into the context of the real world, where human nature introduces several complicating factors.

First, bureaucracy happens. If you believe that the federal government can improve efficiency of service by streamlining and centralizing, you might as well stop reading now; you are obviously living in pretendland, and nothing else I’m going to say will have any effect on you.

Second, third parties make poor decisions. In a pure market system, each healthcare transaction is a decision made between a patient and his/her physician, the two people who can make the most informed decision, both in terms of quality and cost. When a third party payer is introduced (whether insurance company or the government), some of that decision making authority is removed from the patient and physician. The further removed the decision maker, the less informed the decision.

Third, incentive works. People work harder when they have something to gain from it. Averaging of results removes incentives by limiting rewards for risk-taking and hard work. This stifles innovation and lowers quality for all. So the problem is compounded; not only do we all get average health care quality, but the definition of “average” actually gets lower and lower.

Finally, power corrupts. This is the fatal flaw of Marxism, Leninism and all other theories of centrally planned economies. Utopian idealists believe in their hearts that the solution is to find the right people to be in control. They think that non-greedy, fair-minded types with lots of higher education will be able to make it all work. But even if you start with a well-intentioned, benevolent, non-corrupt ruling class, they will soon be replaced by ruthless, power hungry people that are attracted to the power like bugs to a streetlamp. The power to make arbitrary decisions regarding life and death issues, with trillions of dollars at stake, is at best a sure formula for corruption and at worst a giant step towards totalitarianism.

Everyone can’t have the best of anything. If we deny this fact, we produce results that are at best average, and at worst, disastrous.


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