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Wednesday, September 27th 2006

Greed As Fuel

The New York Times has once again taken up the chime, “We have to spend it on something!” and Medical Rants has picked up from there.

I actually agree with Dr. Centor, but I’ll play devil’s advocate here.

Over the years I have opined that health care costs are increasing because we do more things to improve quantity and quality of life. While I believe (and I am not unique here) that I could personally design a health care system that would save some dollars, I could not prevent health cost inflation.


The important issue here is that we understand the trade-off. We cannot cut health care spending and then complain about decreasing health care quality.

But the counter argument, the entire point of proponents of single payer is that other countries do health care for cheaper with NO loss of quality. Claims that we cannot cut healthcare spending or provider reimbursement without sacrificing quality don’t sit with these people.

I think that quality has many measures. Comparing quality between countries is difficult, especially here in the U.S. considering Americans live the least healthy lives in the entire world. Anyone who has been around the blog probably knows my greatest pet peeve when discussing the current American health system is speakers who say – “We spend the most on health care but have the worst outcomes!” or something along those lines. They imply a directional relationship that is completely 180 of the actual one. We’re one of the world’s fatest societies, we have one of the world’s largest diabetic populations and in both those categories we’re one of the world’s fastest growing nations. The reason we’re sicker isn’t a failure of the health care system necessarily but of unhealthy lifestyles. And the reason in part we spend so much on health care is because we’re sicker.

I completely concede the waste of the American health care system and realize that Big Mac plays only a part (and maybe a small one) in increasing American health care spending. But the fact Americans are unhealthier by choice than other nations also has a major impact in trying to compare national health care systems.

Disparities in health (not health care) such as expanded on above make comparing quality variables across cultures difficult. That doesn’t even speak to a problem in determing what those quality variables should be. Less traditional values like waiting times for “elective” procedures must go into any measure of quality. These are issues gripers about the American health care system selectively ignore.

Ohhhhhhh Yeah. The American Healthcare Provider.

Beyond that, and I don’t mean this to sound greedy (although I’m sure some will read it that way), but I believe that many countries which achieve health care at lower costs undervalue health care. I’ll say it here – that ugly word – socialism. It can achieve lower costs without sacrificing many (but not all) important measures of health care quality, but it sacrifices other things (and not just the physician’s bottom line) in terms of liberty.