Views on the Costs of Health Care

There were two articles today which reflect on the ultimate cost containment in Health Care. The first is by Boudreaux who is a conservative professor of economics at George Mason. The second was in the NY Times discussion Obama and his grandmother. Boudreaux states the old adage that if several people have dinner and all agree to equally split the cost then this is an inducement for one or more to order the highest priced item on the menu. There are several flaws in that argument but let that stand. The second is the problem of Obama and his grandmother. he was dying of terminal cancer at 86 and she broke her hip. She had the hip repaired and died two weeks later, from either the cancer or broken hip. The issue was should Medicare pay for hip surgery for someone who is going to die anyhow?

These two stories are quite different but reflect in essence the same problem.

First, why do people go to physicians and hospitals:

1 Primarily in youth due to accidents and in old age due to chronic ailments. Broken bones and congestive heart failure. Chronic illness in the aged is frequently life style related; smoking, drinking, over weight, and failure to have preventing care. Some of the chronic old age problems are genetic, but less than half.

2. Many older people do not go to seek medical care until it is a more sever problem. They generally avoid care because they fear the worse. The avoid care during that period when it can be mediated and the impact reduced. It is a deadly cycle. You see that 65 year old widow in the emergency room at 3 AM Sunday with an impacted colon ready to burst because for the last month she feared she had cancer and was afraid to see the doctor. Now, in addition to the neoplasia she has septic shock! How does one stop that, she had Medicare, yet she was terrified. She did not select Boudreaux's fillet Mignon, she was terrified. Economists have no experience of the emergency room and the fears of the elderly.

3. The Obama problem is a simple one, human dignity. If his grandmother needed surgery then he had a moral duty to see that she received care. We as a society have a moral duty to see that such a person is cared for. Yet, at what level for society? If society decides it is palliative, then a person of substantial means like Obama has an overriding duty, honor thy parents, to see that she is taken care of. The end point is a moral imperative, respect and care. The way to that end point may be open for debate. Who has responsibility, those with the means such as Obama, or society in general. Who gets the fillet Mignon and who gets the chicken?

4. Stuff happens. There is a percent, albeit much smaller than the percent of chronic illnesses, of people who have catastrophic illnesses. These are the brain tumors, the ALS patients, the MS patients, the ones who have gotten various leukemias, melanomas, and the like. Here society also has a moral imperative to assist those people so that their families and the person themselves are not financially destroyed as well as physically. The 39 year old mother with a glioma and three children, with a husband working two jobs is what I am focusing on. This requires the rally round approach, there are few people like this, more than there should be, and yet we as a society have a moral duty to assist them as best we can.

This Boudreaux points to a small group of people who choose the Beef Wellington. There are just not that many. Patients do not choose one surgery over another. A patient with a disorder seeks to be cured or at least regain some quality of life for as long as possible. I have no idea what the Boudreaux argument is based upon. The Obama story is more complicated. Clearly the end point is without doubt, but who pays for that end point is a question. Should multi-millionaires get Medicare at the same cost as say a retired telephone company lineman? That is the way it is today. Most likely that will not be the was it will always be.