Monday, December 7, 2009

Is "Health-care nation" a bad thing, or a good thing? The elites have one view, the people have another view. Which will prevail?

Robert Samuelson, the veteran writer for The Washington Post, makes it clear, in his column this morning, that he thinks "health-care nation" is a bad thing. That is, the idea that we have committed 17 percent of our GDP to healthcare, with the prospect of spending a lot more than that.

But is health-care nation really so bad? Is it such a bad idea that Americans are focused on their health? And if the people do focus on their health, is it not possible to see whole new industries developing to better serve the rest of the world, as other peoples focus increasingly on their health? That's billions of potential customers, benefiting, among others, our own American healthcare industry.

But for Samuelson, "health-care nation" is clearly intended as a dig, in the vein of Fast Food Nation,the muckraking 2001 book by Eric Schlosser, which attacked our burger-and-fries culture.

The shared presumption of both "health-care nation" and Fast Food Nation is the idea that Americans don't know what's good for them, and that haute cultural critics, such as Samuelson and Schlosser, will guide hoi polloi toward better decisions about food and health.

Here's what Samuelson said this morning about healthcare spending:

All this is transforming politics and society. The most obvious characteristic of health spending is that government can't control it. The reason is public opinion. We all want the best health care for ourselves and loved ones; that's natural and seems morally compelling. Unfortunately, what we all want as individuals may harm us as a nation.

That last sentence is worth dwelling upon, because it goes right to the heart of the Establishment worldview on healthcare. So let's repeat it:

Unfortunately, what we all want as individuals may harm us as a nation.

In other words, Samuelson is saying, we can't all get we want. Oh sure, the rich and powerful will get what they want, and we shouldn't worry about that too much, but if the masses, too, start getting what they want, well, that's trouble. Let's see: Where have we heard this kind of argument before? Can you say, "Louis XIV"?

Why is it a priori bad that people spend more on healthcare? Of all the possible things to consume--from "mcmansions" to machine guns, from fine art to Facebook, why is healthcare spending to be so vilified?

Is 17 percent of GDP really too much for us to spend on healthcare? As Louis Woodhill observes, if we were spending 17 percent of GDP on software, nobody would complain. Heck, nobody would complain if we were devoting 25 percent of GDP to software, or more, even, than that. Why? Because people think software is cool. It's an expenditure that passes aesthetic muster with the elites.

In a free country, expenditures per se should not be a great source of concern. In a free country, the presumption is that if people want it, they should be able to have it. In free country, the aggregation and satisfaction of personal wants is known as a "market," and is also known as "prosperity."

Yet expenditures are a source of concern to some, because some people just can't resist expressing an opinion, usually critical, as to how other people live their lives, and how they spend their money. And yet in a dynamic economy, choices and preferences are going to be changing constantly. So we just have to learn to roll with it, that's all.

Over the last century, expenditures for food, for example, have plummeted as a share of overall income, while expenditures for leisure have risen. In neutral economic terms, these changes are the result of rising productivity and prosperity. Food has become cheaper, leaving people with more money for leisure--and the leisure industry, from amusement parks to radio to movies to TV to videogames, has grown enormously. (Obviously some expenditures bring with them costly "externalities," and so we quite rightly restrict weapons of mass destruction and pollution--even if you personally can afford an A-bomb, society still doesn't want you to have one!)

But healthcare has positive externalities. If people are healthier, they are more productive and they live longer. And living longer, contrary to what many say, is a good thing, not a bad thing. Not only do people naturally enjoy a long life--and reward the politicians who help them live into their golden years--but a longer life means a longer working life, and that means more economic output. Life expectancy in the U.S. c. 1800 was around 35. In 1900, it was up to 47, according to How much work and output do you get out of people who die so young? What's the financial and social cost of families being deprived of breadwinners and caregivers?

Today, life expectancy in the US is pushing 80, and we are the richest country in the world. And all the other rich countries, too, have long life expectancies.

Of course, there is always room for improvement. Americans could eat healthier, and exercise more, and smoke less. And over time, improvements can be made. No doubt, for example, Schlosser's book has had an impact on eating patterns.

Furthermore, it can be argued that we are spending too much money on "futile care," as in, changing bedpans for the comatose and those stricken with Alzheimer's. Of course, to label someone as "comatose" is to skip over other possible names for that individual, such as "mother," or "father," or "loved one" or "dear friend." That's why nobody in electoral politics is too quick to try to pull the plug on anyone--if for no other reason than, as we have seen, the small "d" democratic system will put a stop to such efforts. (See "death panels.") Which, of course, drives the elites crazy, as they think about red ink in the future--or the peasants getting too much.

But if the elites were as smart as they like to think they are, they would be looking to use our healthcare expenditures as an asset to be leveraged, not as a liability to be squelched. Ask yourself: In the short run, with unemployment at 10 percent, is this really the time to cut back on labor-intensive healthcare spending?

And over the long run, the elites might figure out that, in fact, there are cures to be found in the thicket of millions of sick people, and trillion-dollar health expenditures. That is, lots of demand. And it's through cures, and only through cures, that we can bend the cost curve.

Cures bend the curve.

Use research and development and mass production to make people healthier--that's a win-win.

Unfortunately, the elites don't seem interested in solutions, only criticism.


  1. Thought provoking post.

    Same as Climate Change, this is nothing more than a giant money and power grab by those who fancy themselves as 'the Intelligentsia,' and in the process seek to enrich and empower themselves (look at Al Gore, books, Carbon Trading co. investments, investment in Fisker Electric Cars).

    All that healthcare really needs is introduction of real competition and free markets.

    The govt. acting as traffic cop, and ultimately money pass through(which is what Public Option is really all about), is antithetical to efficiency, better medicine, lower pricing. But of course it is great for political entrenchment, creating new dependencies, the future need for 'Blue Chip' panels to deal with inevitable overruns, as has been seen with Medicare-Medicaid-Social Security.

    The beat goes on!

  2. "Americans don't know what's good for them"?
    True, we elected BO.
    However, our life expectancy is 80.
    Gee, 'Hill People', how did that happen? It certainly wasn't your management of Healthcare!
    I guess maybe we capitalists know something after all.
    How about Tort Reform?
    These so called 'Elites' aka "No Nothings" need to stay the hell out of "We the Peoples" way; otherwise, come next November, BTW - the 'new spring cleaning month,' they will find their keisters on Pennsylvania Avenue and be the "NEW Unemployed!"
    Now that's a very nice thought!
    Any 'Amens' on that last point?

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  4. Health care is not a good thing. Health care is not a bad thing. Health care is the *next* thing! Science based innovation reduced the need for workers on the farm, so they went into manufacturing. Now science-based innovation (*speeded* by globalization, but it would have happened eventually) reduced the need for workers in manufacturing, so employment has migrated into services. OK, what is the *ultimate* service, the one the American people value most? What the creator of this blog calls Serious Medicine!

    So why should we be surprised if there is irresistible economic/social/political pressure to move resources out of "yesterday" and into the "tomorrow" the American people really want?

    I would ask all readers to give some thought to the following question: If we don't want our Best and Brightest going into Serious Medicine, where *do* we want them to go? Wall Street? We saw what they did there! Marketing for fast-food companies? The State Department where they can come up with new justifications for sending more American soldiers overseas?

    Where will all this progress end? When we have flat-out *beaten* Disease, Injury, and the Incapacitation That Comes with Aging, what will people do for a living *then*? Consult the master:

    > "For suppose that every tool we had could perform its task,
    > either at our bidding or itself perceiving the need, and
    > if· shuttles in a loom could fly to and fro and a plucker
    > play a lyre all self-moved, then master craftsmen
    > would have no need of servants nor masters
    > of slaves."

    -- Aristotle

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