No Free Lunch in the ER

An editorial  in this morning’s New York Times outlines the leading presidential candidates’ positions on health care coverage, albeit in single-paragraph, cocktail party cliff’s notes capsules. Handy. More helpfully, the Times throws an ice cube or two into the mix:

Sadly, none of the leading candidates, in either party, has the vision or the political courage to propose radical solutions for the big underlying problem behind America’s health care crisis: the inexorably rising costs.

None of them is proposing a “single payer” system run by the government. And all bend over backward to reassure people that they can maintain their current coverage if they like it. Their political goal is to head off opposition from those who fear that their own coverage might suffer in the course of covering some 47 million uninsured people.

It has always seemed to me that the “we’ll just roll back the Bush tax cuts” solution was a bit of a nostrum.  To be sure, rolling back the most egregious cuts would constitute baby steps toward restoring a sense of justice in the land. But the details are vague. And the problems are big.

All of the plans, both Republican and Democratic, fail to provide a plausible solution to the problem that has driven health care reform to the fore as a political issue: the inexorably rising costs that drive up insurance rates and force employers to cut back on coverage or charge higher premiums. All of the plans acknowledge the need to restrain costs, but most of the remedies they offer are not likely to do much.

Electronic medical records to eliminate errors and increase efficiency, more preventive care to head off serious diseases, and better coordination of patients suffering multiple, chronic illnesses are all worthy proposals, but there is scant evidence they will reduce costs. Proposals to import drugs from abroad, allow Medicare to negotiate drug prices, restrain malpractice expenses, increase competition among health plans, and empower consumers to shop more wisely for medical care might help a bit. But many experts doubt that any of this will truly put the brakes on escalating health care costs.

O.K. I’m not one of those experts. But I am qualified to reiterate the point that there really is no such thing as a free lunch. My complaint against Sicko was Michael Moore’s repeated claim that health care elsewhere is “free.” ‘Tain’t.

By way of analogy, I drive down the highway in the summer and find myself crawling for several miles along a construction site. As I brake into the maze of orange cones, a roadside sign cheerily greets me with “Your highway taxes at work!” At fifteen to twenty-five miles per hour, I find myself sooooo happy to know that I paid for this traffic jam. Wheee!

On the other hand, I am happy to drive on highways that hold up, when I stop to think about it.

The key to living well in this imperfect world is to choose our inconveniences wisely. The New York Times is right when it implies that bringing up inconveniences is, well, a politically inconvenient thing for candidates to do.

Nevertheless, grownups deal with life’s inconveniences as they make decisions. Better to put off this to save for that. The inability to do so is known as “poor impulse control.”

While politicians may feel compelled to pander to that segment of the electorate whose impulse controls are poor, the rest of us, like the Times editorial, do well to count the costs and benefits soberly.


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