Healthcare questions for Conservatives

[Broomstick]

@SamuelA

The current system is hugely inefficient, but denying care to poor people does, as I understand it, save it money. Play it out a little :

Person A has the good insurance all his life. He gets twice a year checkups like clockwork (like maintaining a car), and as he ages and gets various minor problems, they are treated with the best available preventative medicine. He gets statins for his cholesterol and prostate meds and blood pressure pills and the effects of all this are checked on a regular basis.

Eventually, person A will still have a medical emergency, perhaps at age 75. He is taken to the hospital in an ambulance and given both emergency care but also followup care, both in the hospital wards and as an outpatient. Several surgeries are performed, and he lives to age 80, where this happens again, then at age 85, where he is taken once last time to the hospital, and he lives for a few weeks in the ICU and then dies.

I see several problems with your scenario, most of them based on the notion that more treatment means better treatment and ignoring probable outcomes.

The utility of statins for cholesterol control, and even when to be concerned about cholesterol, was never as certain as many people think and it coming more and more under question.

There’s a lot of reason to think prostate problems are being overtreated. Certainly, some men need medical intervention but that should be reserved for cases where there’s an actual need.

A person who is terminal shouldn’t be automatically chucked into intensive care. Someone who is terminal should be in hospice or an equivalent and unnecessary or harmful (from the standpoint of easing suffering) medical intervention discontinued. A very, very few will need the ICU but many people dying in the ICU don’t need to be there and might well be happier in a less intensive setting. ICU makes sense if you’re trying to fix something, not so much if death is inevitable.

Again, a lot of this involves demand for intervention that might be useless at best and might even generate harms. More is not always better.

b. The government restricts the supply of medicine by requiring FDA approval and clinical trials even for generic medicine. Also, it costs a billion dollars or more to get a drug past the FDA.

Right, so you want to go back to the days of things like thalidomide, or maybe further back to patent medicine and Radithor? There is a reason for all those pesky regulations.

c. The government restricts the supply of hospitals, nurses, and everything else through numerous (probably necessary) regulations.

If the regulations are necessary then it’s not some conspiracy to limit supply, it’s because complying with regulations is expensive and money doesn’t grow on trees. They’re still necessary.

With restricted supply, the almost complete inability of consumers of healthcare to actually make any meaningful choices on the demand side (since they don’t even know what something will cost until they get the bill and often are in no condition to make decisions on cost), and so on, it’s a mess.

Everyone seems to focus on the finances but one could just as accurately say “the almost complete inability of consumers of healthcare to actually make any meaningful choices on the demand side (since they don’t [del]even know what something will cost until they get the bill and often are in no condition to make decisions on cost[/del] have a medical education and don’t have the knowledge to make good decisions in serious or complex medical situations)”

And as you can see, no “free market” solution can work if the government restricts supply like it does. I’m not saying this would be a good idea - but if you really wanted a ‘libertarian’ healthcare system, you would need to make the government relax regulations on healthcare. Any doctor with a license anywhere in the world would be able to come to America, with a guaranteed visa, and start practicing. Any generic drug would be importable, as long as the manufacturer is licensed in their host country. And so on.

And we’ll have a crapload of quacks, and back to snake oil and patent medicine. No thanks. We actually tried that - fewer or no regulations in an era of free market - and that’s WHY regulations were imposed. Too much suffering and death, even among the wealthy

[SamuelA]

@Broomstick

And we’ll have a crapload of quacks, and back to snake oil and patent medicine. No thanks. We actually tried that - fewer or no regulations in an era of free market - and that’s WHY regulations were imposed. Too much suffering and death, even among the wealthy

You really ought to be less selective in your ‘reading’ of my posts. I said **I’m not saying this would be a good idea **. I’m acknowledging that there would be a lowering of quality. The libertarian answer to that is that the role of the government should be to enforce contracts and enforce honesty.

So in my proposed scenario, which I am not advocating for but I do think it would work, the government would force hospitals who don’t hire exclusively American licensed physicians to admit as such, pharmacies would have to label which drugs are American made generics and which are shipped by the boatload from India, and so on. So in principle, wealthy people could get the same grade of care they get now.

You say “quacks”, but to be totally honest, many American licensed physicians are a least a little quack-like in practice, because it turns out that diagnostics is a crapshoot, people don’t take their meds, and how good a decision can you expect a doctor to make in 3 minutes? Plus some went to medical school last week, some 20 years ago, and plenty make the mental error of assuming statistical validity from their own limited personal experience.

In any case, letting in some doctor licensed in Cuba without making them retake residency (what is required now, which makes them go through the bottleneck) increases supply. The poor can probably get better than nothing care from that doctor at a price they can afford. Instead of how it is now, where you can afford either gold plated medical care or nothing.

Anyways, this is an example of what a conservative/Tea Party “solution” to this problem that would actually work would look like. It’s a textbook case of how you lower prices using market forces.