Wednesday, April 6, 2011

National Health Service Rationing--Nothing new there. And meanwhile, a "game-changer" in the US, if we want it.

The BBC reports that the UK's National Health Service traditional approach to medicine--rationing by queue--is worsening.    Meanwhile, there's hope on the horizon, in the form of a new treatment for heart disease--not that the DC political class seems interested.  

Let's start with the BBC story.  Yes, resources are scarce, but as noted here many times at SMS, healthcare is a good that people want--they will pay for it.  Indeed, it's a "superior good"; as incomes rise, demand for healthcare rises.  And while it's certainly true that incomes have been flat or even negative in many sectors of late, the overall income trend is up, around the world.   And so of course, demand for healthcare has risen.  It's foolish, indeed, to fight something that people want--especially in recessionary times, when the US market, in particular, is looking for new demand drivers.  

For some reason, surging demand for healthcare is regarded as being in a different category from other kinds of demand.  We have to "bend the curve," we are constantly told. But we might ask: What if some "curve bender" had decreed, in 1910, “We are spending too much on cars”?  After all the 1910 thinking might have gone, we have enough cars--defined as the “right” people have them.  And o there’s no need for anyone else to have them, cluttering up the roads, etc.  If such a decree would have stuck in 1910, thus thwarting the Model T and everything else that came out of mass production, lower prices, and higher wages, not only would a whole new industry of been thwarted, but so would the American Dream of prosperity and mobility.   And so instead we'd have a world of relatively few hand-crafted cars--very expensive, and not very good, in spite of the hand-crafting.   What really guarantees the functioning of a machine, we have learned, is mass production. And oh, by the way, speaking  we might not have had the industrial plant that we later needed, in two world wars, to make war-winning vehicles and tanks and airplanes.    

The same process--mass-produce it to make it better and cheaper--has been in medical procedures and devices.  That's how we got from open-heart surgery to angioplasties and stents, and now, to a new kind of heart valve from Edwards Lifesciences, Medtronic, and Abbott Laboratories.   In the words of one scientist, the Sapient Valve is "a game changer," because surgery won't be required--the devide can be snaked into the chest through a catheter.    If it's a game-changer for patients, it will also be a game-changer for healthcare providers.  And assuming that the FDA and the trial lawyers don't find a way to shut this innovation down, it could be a major export item.  

So the goal should be to provide the most efficient, least-obstructed--and therefore cheapest--pipeline from consumer demand to medical supply.  If the government wants to help, it can mostly help by funding the sort of medical research that makes disease and treatment cheaper.   Rationing is not popular, especially in a news-rich environment; indeed, to the extent that rationing cripples the process of ramping up supply--and the lower costs that come from economies of scale--then that rationing process leaves healthcare not only scarcer, but more expensive on a per-patient basis. 

Thus the choice: Do we want less of an item and more expense, or do we want more of an item at less expense--and greater quality?   That should be the no-brainiest of no-brainer questions, but in Washington, the issues are always cast in the shortest of short terms.  If it bumps up the deficit in the next year or two, it's bad.   Period.  End of discussion.   And that means that long term health and wealth are consigned to the present-value dust bin of the over-the-horizon the future. 


  1. Resources scarce?
    Here in America we have survival of the wealthiest! Capitalistic Darwinism is alive and well in DC.
    Boy, have you read the Hill People’s own health plan? Talk about a ‘Health Gap’ between them and the Hoi Polloi.
    So the poor will continue to die and the Hill People really don’t give a damn. Just look at the budget nonsense today. They act like they are Jesus Christ handing out loaves of bread! There is no end to their minting money. And they are no Messiahs. They must have AD .... can’t even remember last November’s vote!
    So, I propose next November we continue to further ‘Politically Euthanasia’ the Hill People; if we can’t cure ‘em, we’ll kill ‘em in the election booths. Yet they still act like they are the 4th persons of the Blessed Trinity. Rangel that one around in your brain. Hell, maybe we should make them all bishops, then we would have to only kiss their rings!
    Jim, when these “Unglorious Basterds” have a health plan like John Q Public, then maybe, just maybe they will listen. But until then, every November I’m gonna hang them high in the election booth.
    If I could commandeer Darwin’s Beagle, I would put all the Hill People on the ship, send it out to sea and have the Inglorious Basterds sink it. End of the human impediments to medicine’s progress’ problems.

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