With the current political drama of health care reform in the US, liberal and conservative views on health and access to health care are front and center in the minds of Americans. Because the US media is so keen to broadcast every twist and turn in this drama, people in many other countries with very different health care systems are also witness to this news.
In some cases, they are even involved to some degree as their health care systems are vilified or praised by those in the US seeking a point of reference for comparison.
Whether or not you are a US citizen and actually have a deep interest in the outcome of the health reform efforts, the public discussion on health care does raise some interesting views.
One such view that seems to clearly divide the liberals from the conservatives in this visceral discussion is the concept of self-reliance in maintaining one's health. On one side, liberals promote enabling access for health care to all and on the other, conservatives promote free markets and self reliance as the solution to achieving health reform.
As is too often the case, however, too many of those involved in such discussions attempt to solve all problems using only their own way of thinking. Too many conservatives promote free markets, limited spending and personal financial responsibility as the end-all be-all to solving such problems. Likewise, too many liberals forget the importance of controlling costs and promoting personal responsibility in their efforts to make health care delivery sustainable.
Health care represents significant spending of as much as 11% of Gross Domestic Product (GDP) in many countries and an overwhelming 16-17% of GDP in the US with costs in all countries continuing to climb. If health care systems around the world are to continue being effective and provide quality care for each of us, it is important to look at the benefits and problems of applying different solutions instead of being ideological about how care should be provided.
Keeping that in mind and looking at the concept of self-reliance with regard to personal health, we can see where the concept has both benefits and failings.
One of the benefits of self-reliance that is often promoted by conservatives is the ability to control costs by having the individual pay for their health costs. The argument is that an individual who pays out of pocket is far more efficient with their spending than they would be if receiving the care for "free". This concept can work well if the health costs are within a reasonable range as in the case of minor health problems, but in other more serious situations, the results are less desirable.
Unless you are educated with medical training, you cannot diagnose yourself or determine whether you should or should not visit a doctor. Furthermore, most of us are not in a position to decide whether or not to receive treatment. When such decisions become overly financially motivated, bad judgment by individuals trying to save money will lead to worsened health and this can actually lead to higher cost medical care.
Another problematic aspect to this approach of directly paying for health care is with regard to saving for health expenses in advance. The nature of illness and injury is that medical costs can be very hard to predict up front. Aside from the independently wealthy, most people will struggle under the weight of medical bills for serious illness.
Even in countries with universal coverage, people's financial quality of life diminishes when they are on long term disability or simply unable to work. The reduction in income limits the available money for spending and paying debts.
While health insurance is the next more liberal approach to dealing with health care beyond personal payment, pure market-driven approaches encourage two negatives with respect to delivery of good health care. One negative from an individual's standpoint is that businesses will cherry pick customers, one's willing to pay more and one's who use very little service.
The problem with this is that health is not like the purchase of other goods and services where an individual has a choice to not buy. An individual who is ill needs care and often cannot delay getting it. This means they are at the mercy of business motivations to maximize profit.
The second negative to purely free market approaches is the concept of budget health insurance plans. Such plans may appeal to consumers, but will not be able provide funding of medical care for more serious health situations. The problem here is that the free market has no minimum standards on what is sold so the public is not protected from plans of little value, especially when they do not know what they are trying to insure against.
All that free “market-bashing" aside, there is a role for profit oriented health care if a public sector baseline exists to act as a control. In other words, if the government provides a health care service and identifies the costs of providing that service, private health care business can compete with the government while being paid by the government. In this situation, the businesses increase their profit by working to more efficiently deliver the service given the fixed fees the government pays them.
The existence of a government competitor ensures quality levels are maintained for the public. It also ensures that the businesses competing with the government are not under funded because the government must also be able to maintain its operations with same amount of dollars. Lastly, by not charging the public directly, providers are limited from constantly increasing cost increases for procedures. Over time, the public can benefit because efficiencies created by business involvement can be applied within the government-run health providers.
While many liberals may cringe at the idea of businesses involved in health care, they do have a role to play in providing cost control and choice to consumers if properly harnessed.
From all this we see that viewing the problems of health care and personal health in an entirely one-sided manner with solutions from only one line of thinking can lead to roadblock and inefficiencies that benefit nobody. Though the ideas presented can be dissected for flaws, the point is that there are many views that lay somewhere in middle and have merit in promoting better health systems and better individual health.
The next article published will cover the other half-truth associated with self-reliance and personal health.
Please feel free to share your comments and criticisms.
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