
Health Care Is a Business, Not a Right - eagerToLearn
https://www.bloomberg.com/view/articles/2016-08-23/health-care-is-a-business-not-a-right
======
codegeek
"People need a lot of things. You’ll die without food long before you’ll die
without health care, and yet few people say we need to “take the profit motive
out of farming”."

"Why is health care Special"

I tell you why healthcare is special. You cannot buy healthcare at the cost of
food. I can buy ramen noodles and survive for cheap. Sure it is not the best
but I won't frikin die. But If I get cancer and cannot afford a 100k Bill
(yes, I know a family member who got that bill) , I will die. See ?

Again, people are talking about making Healthcare a right in America is mostly
due to the fact that it is too expensive and difficult to deal with. If that
was not the case and healthcare becomes as cheap as food, I bet people will
stop the whole "healthcare is a right" movement. I would.

EDIT: Read this fun fact [0]. The average cost of health insurance is $17,500
PER FAMILY . Now this means that you may get covered for diseases such as
Cancer but that does not mean you won't get a huge bill even after insurance.
Now imagine you had no insurance and you get cancer. Compare this to average
cost of food [1] for a family of 4

[0] [http://www.ncsl.org/research/health/health-insurance-
premium...](http://www.ncsl.org/research/health/health-insurance-
premiums.aspx)

[1]
[http://www.cnpp.usda.gov/sites/default/files/CostofFoodFeb20...](http://www.cnpp.usda.gov/sites/default/files/CostofFoodFeb2015.pdf)

~~~
codeddesign
Try to eat ramen noodles for the rest of your life and see how your health
goes. Most health issues today are directly related to diet. However,
processed food and snacks are much cheaper (ramen noodles) than healthy
alternatives. McDonald's is a lot cheaper than going to the store and cooking
a meal. So no, food is not cheaper when you try to compare it against
healthcare.

~~~
RealityVoid
I hear this argument continuously, but it does not convince me. You imply that
McDonalds is bad. Why is it so? Mostly because it's very calorie dense, not
because it's actually bad for you. In that respect, McD does its job very
well, too well even, but it's not the food itself that is bad, its over
consumption.

How bad are ramen for you anyway? Consuming it as a large part of your diet,
within your caloric intake and getting the rest of your needed vitamins from
different sources (fruits, supplements even), would you get sick with time?
Why are certain foods labeled as "bad" automatically? t seems this gets
repeated Ad nauseam but most always, the accusation is unsubstantiated.

~~~
codeddesign
Are you trying the imply that eating a double bacon cheeseburger with a coke
and fries is healthy for you?? I do agree with you on consumption, but when
was the last time you heard of someone having health issues because they over
ate on fresh fruits and vegetables? In my comment I was more referring to farm
fresh compared to the highly processed food that is much cheaper.

------
SmellTheGlove
The conclusion of the article is a bit ridiculous. tl;dr healthcare isn't a
right because we can only spend a finite amount.

Yeah, ok, but that dismisses priority entirely. Scarcity is still in play, so
you treat the immediate needs first. I think we do have capacity in the
healthcare system to do it that way. The author of the article basically
bucketed a sprained ankle and a stroke in the same category, and concluded,
nope, we don't have enough money to treat all that cancer, heart attack,
stroke and scrapes and bruises equally, so it can't be a right. I guess, but
who's really arguing for the right to get an ace bandage _right now_? Just
because we have to prioritize access doesn't mean healthcare can't be a right.
Today we prioritize by medical need and by who can pay. Single payer means
everyone can pay, so prioritize by medical need. The right can be subject to
objective need.

~~~
SilasX
I agree the author makes the wrong inferences from the situation, but her
points _do_ often go overlooked in the debate: people make a big deal about
"omg, someone died because they couldn't afford [more] health care", even
though this will _always_ be true, in every system, even the best ones -- you
can't save everyone.

(Similarly, the rhetoric around "death panels" was toxic made this insight
harder to accept.)

~~~
ewzimm
I've had the opposite experience. When talking about the problems of the US
health care system compared to national health systems, the number one thing I
hear is that ours is much more expensive and achieves worse results. One of
the primary motivations behind people who want to nationalize health care is
to reduce costs. Everyone is thinking about costs.

The comparison to food is misleading. With food, there's an aligned interest.
People go to the store and buy your product. If they aren't satisfied, they
buy something else. With health care, most people have few choices. They get
whatever plan is assigned by their employer or whatever they can afford within
their limited market, often one or two possibilities. Then they go to the
hospital, often the only one in the area, which in most cases won't tell them
how much it will cost to be treated.

There's no free market, no choice, no aligned interests. The interests of the
insurance companies are aligned against them. People are paid to deny as many
claims as possible. It often takes years of legal battles to get anything paid
out, even when it's legitimate.

Because even preventative care is unpredictably expensive, most people wait to
be treated until the problem is most expensive to treat.

~~~
SilasX
>I've had the opposite experience. When talking about the problems of the US
health care system compared to national health systems, the number one thing I
hear is that ours is much more expensive and achieves worse results. One of
the primary motivations behind people who want to nationalize health care is
to reduce costs. Everyone is thinking about costs.

Yes, you can reduce costs and get more per dollar invested; it's still a
fallacy to believe that one system will eliminate the problem of people dying
because someone refuses to throw further resources at them.

~~~
ewzimm
Basically, the article is a strawman fallacy. It paints national health care
supporters as people who think, as you said, that health care as a human right
would mean that everybody gets treated no matter how expensive. Nobody thinks
that. The goal is to reduce the amount of people who are sick and dying as
much as possible. We have data on that in the form of the performance of
various systems and their impact on health.

The US is still the world's economic superpower, but it's health care system
is rated below Dominica and Costa Rica.

~~~
SilasX
So was I just imagining all the people repeating the line that 'no one should
die because they can't afford health care'? Or do you not see how that
condition also exists in all the countries that do it right?

>The US is still the world's economic superpower, but it's health care system
is rated below Dominica and Costa Rica.

What is this replying to? What did I say that contradicted this or suggested
otherwise, or merited a re-run of "everything wrong with health care in the
US" as if I disagreed? I was addressing a specific fallacy, not somehow
claiming that everything the US is wine and roses.

~~~
ewzimm
That low ranking is related to the first thing you're saying. It's what drives
advocates of national health care, not the idea that nobody will die.

When people are talking about deaths of people who can't afford health care,
they're talking about people who don't have the resources to ever get care,
the people who don't catch things in the early stages when they're easily
treatable and find out too late that their condition has become terminal. The
point of national health care isn't to eliminate all treatable deaths no
matter how expensive, it's to improve care and accessibility so that it's in a
place that aligns with the resources society could reasonably support. When we
look at much poorer nations being able to provide much better care, we see
that there's a problem that needs to be addressed. That's what people are
talking about, not eliminating all deaths.

~~~
SilasX
Those are all great, subtle distinctions to make. They're also completely
different arguments from, and not at all conveyed by "lol poor people die from
lacking health care in the US but not Europe".

------
scotch_drinker
But it's not a business, not in its current implementation. Right now it's a
implicit government protected monopoly for lots and lots of things. Case in
point: EpiPens which are in the news today. When the government makes it hard
to develop alternatives but doesn't pay for the monopoly it creates, it's
neither a business nor a right. It's a disaster yet that's where we find
ourselves today.

[http://www.nytimes.com/2016/08/24/upshot/the-epipen-a-
case-s...](http://www.nytimes.com/2016/08/24/upshot/the-epipen-a-case-study-
in-health-care-system-dysfunction.html?_r=0)

------
gph
The article does raise an interesting point in that most people don't
necessarily see food as an inalienable right that people shouldn't need to pay
for.

But to counter that point our government has set up a system of farm subsidies
and management to ensure affordable food is available to pretty much anyone...
and even those who don't have the money get food stamps.

Seems like the government tries to do the same thing with the health sector,
yet it still costs more than most people can reasonably afford. It seems like
there are clear market pressures and competition in food production that
drives the price down to a minimum. That does not seem to be the case with
health care.

~~~
jjfine
I thought that was an interesting point as well. I'm having trouble coming up
w/ full argument but one point is that there's huge differences btwn food and
healthcare.

When you only have $20 to spend on food for the week, you don't need to go to
the government for help. You can cook and eat rice and beans all week. That's
what I did in college.

The difference w/ healthcare is there's no rice and beans of cancer treatment
or ER visits. People aren't regularly given a decision between death and going
to a fancy restaurant.

~~~
deelowe
It's pretty easy to institute the life changes needed for you to go from not
having enough food to survive on a daily basis to having enough to survive.

You can't go from not having enough to treat cancer to having enough to treat
cancer easily or ever in many cases. This is like saying FEMA should be a for
profit institution. Getting cancer is no different than having a tornado level
your home. No amount of picking yourself up by the bootstraps will get you
back on track. This is why we have a social safety net. Healthcare is no
different.

------
jimmywanger
This is absolutely spot on.

Health care is not a right, neither is education, food, or access to the
internet.

These are all things that people at some point or another have claimed as
"inalienable human rights".

There is always a cost benefit analysis here. Should we perform this extremely
expensive treatment to give somebody a few days in agonizing pain, or maybe
save a few dozen other people with a simple, straightforward procedure?

The painful part is realizing that no matter what, people with more resources
(money or otherwise) will have better (and longer) lives on average then
people without resources. There is no way to legislate that away. See
Venezuela for an example of that.

~~~
erelde
> Should we perform this extremely expensive treatment to give somebody a few
> days in agonizing pain, or maybe save a few dozen other people with a
> simple, straightforward procedure?

Does the current system in the US evaluate that?

We could also go back to feudalism, people accross history and the world have
gained rights against the wealthy minority, and I think healthcare for
everyone should be something US citizens fight for now.

(It's a bit of a marxist reading of history, but in this case it works)

~~~
jimmywanger
Did you read the article at all? Evaluating the cost/benefit analysis is
completely toxic and forbidden completely.

The NHS does that and denies it, and the last election they tried to call
Obamacare "death boards".

We are in fuedalism right now, we just don't recognize our lords as
explicitly.

And you can't "fight for healthcare for everybody". Healthcare is a scarce
resource, and not everybody gets it. It's the nature of scare resources. If
you have to provide healthcare to all, something else will get cut. Education?
Food subsidies? Housing stipends? You pick your poison and don't think that we
can just produce things out of thin air.

And the two marxist societies in the world are suffering. (DPRK and Venezuela)
They've only been able to make everyone equally miserable, except for those in
the ruling party.

------
clavalle
'Right' is probably too strong a word.

Does a person have the 'Right' to be rescued from a car accident that would
surely kill them without help when it is in other people's power to do so?

No. BUT at some point I think it is fair to expect certain behavior from
others living in civilized society.

A Right? Probably not. But Reasonable Expectation doesn't have the same punch
as a slogan.

~~~
exclusiv
Agreed. I think it's a little damaging to use that word.

If it requires someone else to provide it - it's NOT a right because that
would infringe on another's rights. It's that simple.

It may be the right thing to do to provide it inexpensively, however.

At the same time - so many people don't exercise, eat crap, get obese and
diabetes or other preventable diseases and then overload the system with
expenses. I'm not sure how you solve this issue.

~~~
clavalle
Me neither, not completely anyway. But there are dozens of things I think
might help.

-Make medical debt non-dischargeable if you incur it without insurance. (Encourage everyone to make an accurate accounting of the risk they are putting on themselves and the system without insurance).

-Require price lists of common procedures and tests from providers. (Competition on price).

-Close the medicaid gap.

-Publish insurance standards and require providers to accept all insurance that meet those standards. (This would allow smaller players into the insurance market spurring competition -- it would also be very difficult to pull off -- perhaps tie it to providers that get federal money in some way).

-Incentivise staying healthy by giving rebates for good health.

-Incentivise not using health care by giving rebates for not using it over some period of time.

-Incentivise shopping around by giving rebates based on finding providers/treatments/prescriptions that are below the average. Penalize those that are above some threshold by dinging future rebates.

And on and on. I don't think there is one solution. I think we need to try a
bunch of things and keep what works.

------
az0xff
Despite any implementation problems, I don't believe that someone should have
a worse chance of keeping their life in the face of disease just because they
are not as wealthy. That alone means that society is considering some people's
lives more important than others, which is not a society that I would like to
live in.

~~~
ancap
>That alone means that society is considering some people's lives more
important than others

No it doesn't. Healthcare does not happen through some fictitious consensus of
"society". It happens through individuals interacting one with one another and
forming a natural order. To claim that healthcare is a "right" ultimately
means healthcare providers are slaves.

~~~
fsloth
"To claim that healthcare is a "right" ultimately means healthcare providers
are slaves."

So teachers are slaves? As are judges? etc.

------
DrPhish
Health care should probably not be a right, but universal heathcare has a lot
to recommend it from a social and economic policy perspective. For example,
people who can't afford to see a doctor will eventually end up in the ER, at
enormous cost that can't be recouped, and that could likely have been
prevented. Also, having a maximally large healthy working population is
something that has a direct economic impact

------
MrFantastic
There are no free markets where price transparency doesn't exist. Even
surgeons can't predict what prices will be for a procedure.

Healthcare, because of the complexity of understanding how the body works, is
a natural local monopoly.

Are you going to shop around for a better deal on a quadruple bypass when you
already trust your surgeon? How would you know if the cheaper surgeon was as
good?

Healthcare insurance suffers from the classic agency problem and has no
incentive to keep costs low over the long term because they take ~7% off the
top for a pass through transaction.

------
gsmethells
The current problem is the pricing is completely non-transparent hence
consumers cannot choose based upon price. No one knows what anything costs
until a bill arrives much, much later. In addition, it is extremely opaque how
the numbers on the bill are arrived at.

~~~
waqf
That's not the only problem. For example, another problem is that consumers
cannot choose based upon price because they are frequently in an emergency
situation. Another is that they can't choose based upon price because they are
locked into a health insurance plan which negotiates reasonable prices only
with preferred providers.

------
dragonwriter
> You’ll die without food long before you’ll die without health care, and yet
> few people say we need to “take the profit motive out of farming”

Yes, and the reason few people say that -- even while people _do_ argue for
regulation to limit certain commercial practices in farming that they view as
harmful to food availability, affordability, and/or quality -- is because you
don't see monopolies on basic foodstuffs in the developed world being used to
drive prices on foods that people rely on so high that many people, _even with
the safety net provided by government_ , can't afford essential foodstuffs in
a first-world nation like the US.

That is, because, problematic as it is, the combination of private for-profit
business and government regulation operating in food markets is working
adequately well, such that people are less likely than is the case for
healthcare in the US to perceive that the model under which it is provided is
broken, inadequate for the needs of society, and essential to fundamentally
reform.

History has shown, more than once, that when the systems of delivering food
_are_ perceived to be as broken as the US system of delivering healthcare is
now perceived to be, people _do_ clamor -- often violently -- for change.

------
beeftime
"People need a lot of things. You’ll die without food long before you’ll die
without health care, and yet few people say we need to “take the profit motive
out of farming”."

I'll say this too when I get a $65,000 bill at the grocery store.

------
throwanem
I'm not sure I buy the reciprocal-altruism argument, but the article's thesis
seems ineluctably true, however unsavory.

------
vmorgulis
From the UN Declaration of Human Rights:

Article 25.

Everyone has the right to a standard of living adequate for the health and
well-being of himself and of his family, including food, clothing, housing and
medical care and necessary social services, and the right to security in the
event of unemployment, sickness, disability, widowhood, old age or other lack
of livelihood in circumstances beyond his control.

[http://www.un.org/en/universal-declaration-human-
rights/inde...](http://www.un.org/en/universal-declaration-human-
rights/index.html)

------
johngalt
When you have a NHS you are agreeing on a single standard of care as a nation.
The problem that the author illustrates is that it is difficult to have an
honest dollars and cents conversation about what that standard of care should
be. It certainly can't be 'whatever is necessary at any cost' without
bankrupting the program. Where the dollars do get spent will be determined by
political expediency rather than individual choice. As with most government
programs the incentives will be with what's popular rather than what is
effective. Politicians will get elected to put more money towards $cause of
the day$.

Also consider the moral hazard involved with national healthcare combined with
our two party system and electoral process. Who would be surprised if Iowa and
New Hampshire end up with more hospitals per capita than other states? What if
CA and NY end up with a lions share of the healthcare dollars? What if they
don't?

IMHO, the right way to run a NHS for the US would look very different than the
UK's NHS. Perhaps something similar to a minimum wage. I.E. A federal minimum
standard of care that is uncomfortably low, with state and private coverage
able to build on top of that as determined at a local level. But we have to be
able to look at something like a "death panel" and say 'yes of course that
would be necessary'. Until we can have honest conversations about varying
standards of care, we won't see meaningful healthcare reform in the US.

------
SteveLAnderson
The question the article is asking isn't matched by the headline, or the
conclusion. The points raised in the article come down to this idea - if we,
as a society, want to make sure everyone has access to health care, then we
need to decide how to handle the limited resources available. That's true
whether you think of health care as a right or not.

------
helthanatos
The government pays farmers to burn their crops, as to destroy competition and
raise prices. The government, with the ACA, taxes insurance companies great
amounts and uses that money to pay for the government care; the quality of the
company's care goes down, then.

------
bryanlarsen
That's not an either-or situation. Health care, food, clothing and shelter are
rights and businesses.

The rights are _positive_ rights, in other words they must be provided, and
cost resources to provide. (In contrast to negative rights like freedom of
expression, where it costs resources to take the right away from you)

As positive rights (aka obligations), they must be rationed. Welfare et al
provides enough money to pay for basic food & shelter but not for caviar and
mansions. The article is a very reasonable discussion of why it's harder to
ration health care, but the conclusion (and title) doesn't necessarily follow.

~~~
mariodiana
This idea of "positive" rights is a dangerous, illiberal notion. Who incurred
an obligation to provide healthcare to others? The answer is no one -- not
individually or collectively.

Healthcare is a service, like any other service performed by human beings in
society with one another. If it isn't performed as charity, then it is
performed when the parties involved strike a deal. The alternative is that one
person's "positive right" is another's positive slavery.

------
elviejo
Human Rights Declaration: "Everyone has the right to life, liberty and
security of person."

...and Health Care is how one stays alive, therefore health care should be a
right.

~~~
trav4225
If I truly have such an _absolute_ right to life, then the State should expend
infinite resources in order to attempt to keep me alive forever. No expense
should ever be spared.

~~~
Apocryphon
That is the state of things:

[http://abcnews.go.com/US/story?id=90611&page=1](http://abcnews.go.com/US/story?id=90611&page=1)

[http://articles.chicagotribune.com/1996-03-01/news/960301023...](http://articles.chicagotribune.com/1996-03-01/news/9603010235_1_liver-
transplant-organ-transplant-mitchell-rupe)

------
SilasX
I know everyone's busy re-iterate the usual health care talking points, but I
this part interesting: McArdle says that she went on to a British talk show to
talk about NHS and Obamacare, and the host and opponent both refused to deny
that NICE does what it actually does: a CBA on treatments and recommends
for/against them to the NHS.

(Obama tried to set up IPAB to do the same thing.)

~~~
DanBC
Does she say what the host and opponent claimed NICE do instead of cost
benefit?

~~~
SilasX
I couldn't find a mention of it. Here's the part:

>>...Britain had achieved cost-effective treatment for everyone, at the cost
of some people missing very expensive treatments that might help them. I was
rather congratulating myself on this answer, because NICE is beloved of health
wonks everywhere; Obamacare’s Independent Payment Advisory Board (IPAB) is an
attempt to sort of replicate it. Pointing out something the British health
system can do that the American system can’t, and doing so in dryly factual
tones, seemed like a good way to endear myself to the British audience.

>>The other guest, a British health official, interrupted to basically accuse
me of lying; the British health system, he said, did no such thing.

>>Now I reiterate: I had not called NICE a death panel, or said that it was
bad; I had simply described what NICE does, which is keep the NHS from blowing
its budget on very expensive treatments that deliver relatively little value
per pound spent. You can read NICE describing what NICE does on its website;
the description is not significantly different from the one I gave. Being told
that this was flat out wrong was surreal. Things got even more surreal when I
began again to explain what NICE does, thinking that perhaps I had been
unclear, and the host interrupted me and said something like “As you know,
that’s false.”

~~~
DanBC
How frustrating.

That person was clearly true. It's a deeply unpopular idea over here though,
even though very few meds are recommended against on pure cost grounds.

~~~
SilasX
But that should validate the difficult politics of health care -- even in a
country that gets it (mostly) right, it's because everyone has incorrect
beliefs about what it actually does and how it actually controls costs.

------
athenot
This article strikes me as tone-deaf.

> People need a lot of things. You’ll die without food long before you’ll die
> without health care, and yet few people say we need to “take the profit
> motive out of farming”. (...) Why is health care special?

Why is healthcare special? Because juicing someone's wallet when they are down
on their luck is one of the worst things you can do.

Yes, healthcare is not cheap. And the resources we have to pay for it are
finite. We don't understand everything, and ultimately we will all lose the
battle to death.

So why do we fight? Because we want to live. And most of us want to see those
whom they love live too.

The money argument is especially bad though, because in terms of outcomes
(whether you measure longevity, or not dying of preventable diseases, or not
getting more messed up during treatment), the US scores pretty bad. Yet we
spend the most of any country (per GDP)[1]. Other countries such as the UK,
France or Germany spend less, do contain costs and have better outcomes.

What making it a business does is reduce overall efficiency. If the major
actors have the ability to take advantage of the final customer's weakness
while maintaining a fiduciary responsability to generate profits, then money
that is spent for the purpose of getting well gets diverted into pure profits.

Exhibit A: drugs. In France drug companies negotiate a market price with the
payor (government). They are still able to turn a profit in that market alone.
Not a huge one but decent. They then take the same drug, patent it in the US
and sell it for 4x to 6x the price. Keep in mind the R&D was already paid for.
So that is pure profit (minus marketing and regulatory compliance costs).

[1]
[http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS?year_high...](http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS?year_high_desc=true)

------
cmiles74
It'd be nice if we were in a place where the main ideas in this article,
providing the health care people can afford and no more, were somewhat
applicable. Unfortunately people in the US literally cannot afford any health
care of any kind, aside from over-the-counter items like Band-Aids and cough
syrup and those kinds of items won't get you very far. Forgetting this, or
leaving it out of the article entirely as the author of this article does, is
dangerous and misleading.

It seems obvious but the article forgets to mention that since health care is
so expensive and no one can afford it, everyone buys health insurance. Even
health insurance has become expensive to the point that no one can afford it,
people need a larger organization to help purchase this insurance on their
behalf (like their employer or now, the government). Now we've reached the
point were even that has become too expensive. The guy in the cube next to me
broke his hand skate boarding and is spending almost 1/10th of his salary on
covering the cost and he's employed.

For sure, the history of health insurance and health care in the US is
complicated and it's not as straightforward. But that is where things are
today: unless you are wealthy or work for a wealthy company, health care is
the kind of expense that can balloon out of control, despite purchasing
insurance. In my opinion, that is what people object so vigorously to:
spending money on health insurance (and a lot of it) and still having to miss
car and mortgage payments so that they can give more money to doctors and
pharmacies and hospitals to keep their spouse or children or themselves alive.
You can choose to skimp on food, few of us would choose to willingly lose a
loved one because "we can't afford it."

If I had to choose what should be made non-profit, my first choice would be
insurance companies. By definition, for-profit companies would like to make
more profit every year. There's a clearly unhealthy co-dependency between
insurance companies, pharmaceutical companies and hospitals. Fixing it all in
one swoop is probably impossible, but one way to make health insurance non-
profit is to make it government run. We can't seem to get that done, so now
the government is trying to join workplaces in helping people to buy
insurance. It's the simplest and probably the only legal solution so that's
the one that is being pursued in the US. We'll see how it goes.

