Health Care Is Not a Commodity | National Catholic Reporter

Health Care Is Not a Commodity | National Catholic Reporter by MSW. MGB: Health care usage responds to supply and demand - which means it really is a commodity.  This is why the GOP wants to end the tax benefits for employers who offer comprehensive insurance (which was offered because workers were an expensive commodity - more expensive than wage and price controls allowed to pay them) and replace it with a tax credit big enough to buy a catastrophic policy, with some provision made for a Health Savings Account to fill the gap - at least partially.  Most economists actually think this makes sense - as comprehensive insurance invites overuse of services, especially in so called Cadillac plans.



The reality is that the Affordable Care Act was designed to give hospitals someone to bill, rather than having to deal with uninsured patients - and to direct care elsewhere - although that is hard without madatory sick leave to take your sick kids in.  I was in the Alexandria Hospital ER a few years ago with chest pains and the lobby was full of kids with the flu and their working class parents.  Without paid sick leave as a right, rather than a privilege, this will continue.



The problem with that is in a labor intensive business, like a restaraunt, sick leave leaves huge staffing holes where staffing is done without much slack.  You would think that getting a meal from non-sick people would be a right, but danger to all who eat out during flu season.  Its not that kitchen and wait staff are well paid, but the margins are short because restaraunts sit on premium land and its the rent that must be paid - whether you have covers or not.



Single-payer is hard to do, because it denies the right of insurers to offer this line of business except as an adjunct to the government run plan (the same people will process the paperwork and will be paid by the same firms, regardless).  Since insurers have a constitutional right to buy members of Congress, it will take a real movement to pass single payer, which will better commodify health costs because the goverment will have the power to squeeze monopoly benefits out of the system (most drugs and hospitals operate in a monopoly and monopsony environment, which is why employees - even doctors - are on the short end of the stick).



The best way out would be a national health service.  We can start with increasing the U.S. Public Health Service to treat Medicaid patients, including behavioral patients, as well as the uninsured.  Then expand to Medicare and lastly become a monopsony buyer (and monopolist seller) of health care.  Then health insurance really would be a right.



The other best alternative is in a cooperative economy.  In order to opt out of single-payer or national health service tax payments, employers, likely cooperatives, would hire their medical staffs rather than pay for third or second party providers.  That way the group who pays is also the group who can control costs - the supply and demand could therefore by synchronized and people will get the right amount of health care.



The main market problem with care is that it is not a normal good.  People do not use it as a budget item.  If you are sick, you go to the doctor and the doctor - with minimal consent from you - orders tests or does treatments.  If I had known that my chest pains were most likely from a cramp, I would not have consented to a stress-radioloogical exam that, while replacing interventional radiology, was not really needed.  If someone told me it was unlikely to find anything - or even said what the situation was, I would not have had that test.



Now, as for moral tone, the question is morality for whom?  For doctors?  For hospitals? For taxpayers? For drug makers?  For gynecologists and their patients?  The reality is that both politics and economics ARE moral fields.  When we in policy talk of wanting ethics, we sometimes forget that we deal with ethical questions - like all of the above.  Ethics cannot be reduced to the calls people get upset about, like abortion or end of life care - ethics is the whole thing - so it is all a moral discussion.  Everyone in the thing has human dignity, including drug company researchers, to an extent - their executives - although CEO morality needs a deeper study, and even abortion providers who see their work as very moral because the alternative is deadly care (often self induced - as the fallout of Trap Laws has shown again) takes two lives.



These are serious questions that cannot be off-loaded to theologians - unless they also have public policy degrees (which is what I have) or degrees in law (where they do deal in rights - including intellectual property rights - as well as the common good).  Ultimately, in our system, it will be the legislators who decide.  God help us.  Of course, if they act like grown-ups, we will get a decent result.



What will actually happen?  Eventually we will get u public option  and the number of people covered will expand until it essentially becomes a single payer program - or the ACA's light mandates will allow people to sign up when sick and drop when healthy, leading to high permiums and unsustainable private plans, which will go into bankruptcy and become single-payer plans under court supervision.  We will get there anyway, the question is how soon and with how much disruption. Again, that last bit will be up to legislators and lawyers.