Paying The Bills

                                                                                

Percentage of United States budget for Health Care:ⁱ

Other health care costs:

Total cost of your health care:

I'm not a sophisticated economist. No. Change that. I'm not an economist. But my mind wandered a little this morning and I started wondering about health care costs. The presidential election's over now, and with it the rhetoric that usually clouds such issues with the complicated overlays of emotion and politics that make any real understanding difficult at best.

So I have the luxury of considering [selected] numbers without having to factor in such distractions [from the numbers] as guilt, responsibility, and the purpose of society. It's even easier since I've decided not to look up the numbers right now. I'll do that presently – after I've given some thought to the nature of the problem. Only then, when we both have a little more information, can we try to quantify it. I may be surprised and find out that no problem exists, but in the meantime I can give some thought to the way we manage money in our current society.

So let me get to some basic considerations, and they're really considerations of human nature. Because I spent most of my life in medicine (no, not taking, it but working as a physician) I'm focusing on health care. I noticed early on – in fact I noticed as a college student before I became a doctor – that there was a paradox in the cost of scientific glassware. It was both unconscionably expensive, and it was free. It was “free” because someone else was paying for it – usually the government or a granting foundation – but the price was inordinately high because the vendors knew that the people ordering it weren't paying for it themselves. And very often they didn't even need it. I also learned that there was a basic rule that you always spend all of the money given you, or you may get less the following year.

That's the way money management works. An individual may be very careful with his own budget, but will freely disburse what he doesn't see as his own. And he'll spare no effort to increase his intake – as income for himself or as money he can give away or spend on others. There's always an organization or some sucker with deep pockets who can be convinced to pick up the slack.

But that philosophy is one that involves not only people: governmentsⁱⁱ have little hesitation about spending our money on programs that sound good, and we don't care – especially since we don't recognize that in the end we'll wind up paying the tab. More likely our grandchildren or their grandchildren will wind up with the bill. We're paying for the generosity of those who preceded us. We're paying for their guilt and magnanimity, and our descendants will pay for ours. Actually we're only making the interest payments, but sooner or later our creditors will demand that we – really it will be those who follow us – start paying off the principle. That principle is the National Debt, which now amounts to … (I'll look that up later, too). We keep kicking the can down the road, but sooner or later someone will get it and have to open it – and it's a real can of worms. Greece knows that.

The needy, however, are everywhere, not just in our country. And they suffer not only from poverty but from disease and oppression.ⁱⁱⁱ The basic idea, and it is a beautiful one, is that we are all responsible for each other. In the Western tradition, the Bible tells us to help the poor, the widow, and the orphan. “Love thy neighbor.” And I have no doubt that there are similar injunctions in all other cultures. But religious teachings often place limits on the amount that one can give away, and realpolitik governs the extent of involvement we're permitted in the affairs of other countries. We're not always wise to try to care for all of humanity, nor are we always free to do so. We know about the tribulations of those around the world, but we can't afford to deal with all of them. And, many believe, it's not our place to do so.

That, however, is neither here nor there. At least it's not the subject of today's discourse. More to the point is our consideration of the cost of caring for the health of our own citizens. That used to be a family obligation but not any longer. Now it is a duty that has devolved onto society in general, even if we may disagree on what standards we should use to judge it^iv and those who receive it, we all pay for it.^{v vi} We consider it self-evident that those who can better afford it than we should pay more to support the kind of care that all our citizens deserve.^vii

Oh. I finally got around to checking. Health care makes up about 23% of the national budget. Apart what you pay for your own care, $230 of every $1,000 you pay in income taxes goes in that basket.^viii As well as 23% of what you pay in a variety of other taxes you pay – like tariffs for imported items – and the costs incorporated into the prices of whatever you buy. The latter reflect producer's and manufacturer's costs that are simply passed on to the consumer. Congratulations. The bottom line is that you're probably paying not only for your own medical costs but for those of others as well. I trust you feel magnanimous.

By the way, our National debt now is over $16 and a quarter trillion and rising rapidly with each new program. But who cares? There isn't any real problem (for me). It's only money, and soon enough it will be someone else's burden.

Next episode: “Growing Down” – It's a tall order.

i      By the way, the use of health care costs is only an example The same issues and calculations can be considered for all parts of our budget. I won't look up any numbers for you though.

ii     Or, more accurately, our elected representatives who are looking for votes in the next election.

iii    Sickness doesn't stop at the water's edge. Nor does guilt.

iv    We wish to raise our standards, but as more and more individuals become eligible for subsidized care, as payments for that care diminish, as medicine becomes more assembly-line, standards are more likely to diminish.

v      That includes Christian Scientists and others who may oppose the programs in general or some who oppose particular parts for religious reasons (like those who consider abortion to be murder). The First Amendment guarantee of religious freedom does not extend to health care.

vi      The reimbursement for some services can be lowered artificially, but that doesn't actually change the costs of performing or providing those services. If it leads to a lowering of salaries it will drive the best practitioners into other fields, diminishing both the number of providers and their quality. It may be necessary to enlarge the bureaucracy to supervise these services even if that will raise costs. The more people involved in regulating and minimizing the costs, the higher they'll be. But it will provide jobs.

vii    “From each according to his ability to each according to his needs.” It was good enough for Robin Hood and it's good enough for us (even if it's not clear who decides on ability and needs). The redistribution of resources makes a lot of sense in a society that prizes equality. Those who view Marx's words ("Jeder nach seinen Fähigkeiten, jedem nach seinen Bedürfnissen!") as a call for socialism are simply mean-spirited. And those who fear that this kind of redistribution will lessen the initiative of the capable are fear-mongers. We'll all work hard and work long hours to support those who don't.

As for those who contend that actions of this sort are contrary to the ideas of the Founders, they should be aware that the Declaration of Independence and the Constitution are outdated, and we now have the Supreme Court to make the laws.

viii   As you must certainly realize that is the amount expended by the government only. It covers Medicare and costs that cannot be paid by the poor and the disabled. It does not cover your costs to private insurers (I pay for long-term insurance to protect my children), deductibles, and out-of-pocket expenses for medications and the like.