Friday, October 31, 2008

SO WHAT IS HEALTHCARE?

As mentioned below, healthcare is not a right. It has not been recognized as such by the Supreme Court and more importantly it cannot be practically treated as a right. What those who advocate a right to healthcare are proposing is that halthcare be "declared" a right, but this is simply a euphemism. What they really advocate is that healthcare be treated as an entitlement. This is just as impractical however, since the practical limits on recognizing healthcare as a right also apply to viewing it as an entitlement; one that would prove unworkable in practice.

Some people make the false distinction between rights and privileges, concluding that if healthcare is not a right, it must be a privilege. This is not true, as a provider's obligation to provide healthcare services arise from ethical concerns and contractual relationships. They are not privileges bestowed upon a privileged class to be exercised at the pleasure of the favored. The consideration of healthcare in terms of rights and privileges is pointless, because such consideration only seeks to identify a source by which services must be provided, and a rationale by which they may be accessed. These are secondary concerns.

First and foremost, healthcare should be thought of as a limited resource. It is not a social amenity that flows undiminishingly from government altruism, the supply of which is both created by, and is wonderful proof of, community compassion. Healthcare rather is a worthwhile endeavor that is subject to human folly, greed, virtue, and humanity. It is limited by hard choices and the often unacknowledged inadequacies of medical science.

A sound healthcare policy is impossilbe without first recognizing that healthcare is a resource, limited by a finite pool of talented professionals and the practical divide between what is desirable at any cost and what is possible in an economically sustainable system.

One of the great difficulties in managing healthcare as a resource is that conventional methods do not apply. If the government wished to conserve limited resources it would do so by taxing their consumption. If it wanted to encourage development of resources, it would subsidize their production. When the government "provides heathcare" meaning that it acts as the middleman to process payment form the taxpayer, on behalf of the patient to the provider, it in effect subsidizes the consumption of a limited resource. More importantly, it subsidizeds the demand for the resource, leading to inexorably higher costs, as the supply is subject to more practical limitations. This inevitably leads to rationing on the basis of cost.

A more realistic approach is to have any subsidy (if at all) directed toward development of those therapies that are, or will be, cost effective. This obviously also is a form of rationing, but is rationing on the basis of cost efficiency. This has the benefit of favoring those therapies that are not necessarily cheaper, but cheaper for the benefit they provide. This would not deprive patients who are willing to to pay for less cost-effective means of therapy of their choice of care; it would simply use market mechanisms to select out the most cost effective medical practices to make the overall system more efficient..

1 comment:

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