The economics of the healthcare bill being considered in Congress are really quite simple. We have about 350 million people living in the U.S. Less than 50 million are without healthcare insurance. Notice that not having insurance does not mean not having healthcare – only that they don’t have insurance, a distinction often lost in the chatter.
Still, it does mean that 45 – 50 million uninsured utilize healthcare services less than the insured. This point is critical to understanding the economics of healthcare.
If those 45 – 50 million are brought fully into the system, including the 12 – 20 million who are here illegally, they will utilize more services. We can argue whether that’s a good result or not, but in any case it means greater demand for medical services without a countervailing increase in the capacity of the system to handle them. You can’t expand facilities and qualified staff that quickly, especially if one of the stated goals of reform is to squeeze costs.
So at the time the proposed system is piling on new demand, they are at the same time demanding “concessions” from the providers.
A rudimentary understanding of supply and demand, clearly surpassing that of policymakers, should at least hint that those “savings” and “cost cutting measures” have to come from somewhere. Increasing demand while deceasing supply must cause a shortage, and that’s exactly what leads to a temptation to ration.
If you were a government actuary and someone asked you to determine where the bulk of healthcare costs accrue and therefore where the bulk of cost savings might be, you would cite studies that indicate the greatest expenditures occur at the beginning and end of life. Therefore major cost savings can come from working both ends of life’s spectrum. And it’s relatively easy to control costs at both ends – if the people charged with controlling costs have the power to control treatment protocols.
At the beginning of life preemies can wrack up tens of thousands of dollars in treatments. Genetic and birth defects also can burden the system for decades just by virtue of having those babies born alive. More abortions can lower the burden of healthcare expenses for individuals who will never be able to contribute enough to the system to eventually pay for the costs society incurs as a whole. Babies like Trig Palin, if terminated in utero, would provide three benefits to society. First, medical costs would be reduced drastically. Secondly, society would be spared the discomfort of such people appearing in public. Finally, the left would rejoice having one less Palin that needs kicking around, and that alone would make them deliriously happy.
On the other end of life, what business does your 80 year old grandmother have burdening the system with knee replacement surgery when she has already lived past her normal life expectancy? And your 78 year old uncle with cancer? Pain management with hallucinogenic drugs and a room at the pink mansion on the hill a la Brave New World would certainly be an economically viable alternative for him and other useless eaters who can no longer contribute to the political economy.
The logic might strike some as bizarre, but it is the logical end of utilitarian logic.
End of life questions are difficult ones, and they will be no less difficult whether free markets or government mandate is the controlling force. But isn’t it more humane for such discussions to be made by the individual’s family, doctor, and spiritual counsel rather than giving that power of life and death to the federal government? If those guys can’t manage a cash for clunkers program, why would you trust them with your life?
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