We discussed the argument that the inflation of health care costs is not a matter of concern since it reflects technological innovation and our growing wealth.
I think that both of those explanations for the inflation of health care costs contain a large amount of truth. I found Fogel’s projections particularly fascinating. But I don’t think it follows that we should be indifferent to the inflation of health care costs. I basically have two reasons for thinking that.
First, the excess costs that health reforms are aimed at are not distributed fairly. Some of the excess costs of the American system are due to the fact that patients buy services they either do not need or are not worth the cost they pay. If your doctor orders lots of questionable procedures, you pay more than I do (or, I should say, the members of your health plan pay more than the members of mine). Those who purchase insurance on their own pay higher prices than those who buy it through their employers. And those who pay for health care out of pocket pay more than those who have insurance. Americans pay much more for health services than people in other countries do. And, finally, one consequence of the high prices that we pay is that some of us do without insurance and, as a result, care.
The aim of reform is to even these things out, such that there are fewer unwarranted bills, it’s easier for individuals to get group rates, and everyone can afford health insurance. Doing nothing means leaving things as they stand where some pay more than others for services that are equivalent or worse.
Even if it is desirable to fund advancements in medical technology, doing it in this way is ethically questionable. Why not just allow the technology firms to steal directly from random bank accounts? It would have the virtue of honesty and it wouldn’t hit only those who need to use the medical system, as Jennifer pointed out.
To put the point less cheekily, if we think it’s important to fund medical technology, let’s do it above board with everyone paying their share. We have done OK with paying for military technology this way, after all.
Second, the proposition is that the members of our society now should accept the distortions in our lives that the health system creates to fund technology that will benefit people in the future. But people in the future are going to be much better off than we are, due, in part, to technological progress and the general accretion of wealth. Why should people now accept these sacrifices for the sake of those who are better off?
Of course, there are also questions about whether we really need private enterprise to do the relevant research and development. Angell thinks the answer is a resounding “no,” at least as far as drugs are concerned. But my ethical points stand even if the answer to those questions is yes.
As always, I owe one important qualification. I described the aims of health care reform. It’s entirely possible that the reforms on offer won’t achieve those aims. It’s even possible that there are reasons deep in our political system why it won’t achieve them. And, finally, it’s possible that whatever our political system would produce would be worse than the current system. Just pointing out that the present system is ethically questionable does not at all mean that it should be reformed. But, that said, it’s hard for me to believe that our situation is that dire.