Opinion
Health care: Just another commodity?
EDMOND — A friend recently shared with me a brief article on Townhall.com, a conservative magazine titled “Alice in Medical Care” by Thomas Sowell. In it, the writer wonders why Americans are so alarmed about the rising cost of medical care. He argues that there is no more reason to be alarmed about that than about the rising cost of cars or houses or any of a number of modern conveniences. He then applies the same argument to MRIs and pharmaceuticals, and opines that relative shortages of MRIs and medical care in general in Canada and England just make those poor benighted souls have to wait longer to get them, and that this adversely affects their health.
Sowell’s piece reflects a profound and apparently widespread misunderstanding of the fundamental place of health care in the human experience, a misunderstanding that is apparently shared by some of our elected representatives. I addressed this briefly in my last column as the commodity view of medicine. With this view, one approaches health care needs in much the same way as the need for a new car or a dishwasher, or any other article of trade or commerce. We check the price, assess the value, then decide if it will improve our lives, or make us happier enough to justify the cost. And in the final analysis, we can just take it or leave it. And anyone who can’t pay for it can just do without it.
If only it were that simple. The cost of a commodity is a function of market forces. Putting more on the market brings the cost down because increased supply eventually reduces demand. In medical care the opposite often is true — increased supply creates more demand. This distorts the process and, with it, the outcome of medical care.
The outcome of buying a new car is the car. The outcome of buying an MRI is something beyond the MRI, namely an improved health outcome. Health outcomes are harder to measure than the satisfaction of having a new car because their assessment depends on professional judgement. Just buying more care doesn’t always lead to better outcomes, although it does to some extent in cardiovascular disease and diabetes. Even in those categories there are exceptions. Long-term evaluations have shown that some patients who get coronary artery bypass grafts or angiopiasties don’t benefit enough from it to warrant the risks. As a result, less radical interventions may be used now in those patients.
The point is that these choices are not made on a consumer-gone-shopping basis. The desired outcome is improved health.
So, let’s look at health outcomes, and what it costs to get there, here and abroad. The health status of a country is commonly assessed by longevity, neonatal mortality and prevalence of certain cirpronic diseases. Some recently published figures show U.S. life expectancy at 78 years, below that of Canada and most European countries. Similarly, infant mortality in the U.S. is 6.9 per 1,000 live births, higher than in Canada, most European countries, Cuba, Australia, Japan, Taiwan and South Korea. In chronic illness prevalence, a 2002 comparative study of non-Hispanic middle-aged causians in the U.S. and England showed higher numbers in the U.S., in all categories studied, including hypertension, heart disease, diabetes, cancer and stroke. All of these countries spend less per person on health care than we do.
Again, outcomes of diagnostic studies and treatments are not easy to assess, but we can do better than we do now by using currently available information on what works and what doesn’t, and by appropriately studying those problems that still are unanswered. And we can start reimbursing for medical care on the basis of what has been shown scientifically to work instead of how many procedures we can perform. These judgements come from medical scientists, not bureaucrats, as some politicians argue.
Back to Sowell’s piece. He, like many reform opponents, are fond of re- peating second- and third-hand stories about long waits for care in England and Canada — mostly relating to surgery. These are meaningless unless they specify the type of surgery, e.g., knee replacement vs. appendectomy, and can show that health outcomes were adversely affected by the wait. Sowell implies that “government-run medical systems” may cost less but put patients at risk of death by virtue of delay. Unless he has actual supportive data, his statements are not just meaningless, but false.
What reform opponents notably lack is a clear-cut plan of their own. All they can do is reject the one currently under discussion. It reminds me of the old Marx Brothers movie, “Horse Feathers,” where Groucho is in some kind of argument, and sings a little ditty:
“I don’t know what you’ve got to say,
“It makes no difference anyway,
“Whatever it is, I’m against it!”
DENNIS WEIGAND is an Edmond resident.
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