Health Care Is a Business, Not a Right

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...

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.

I would say the government is doing something similar, but still mostly different. The overwhelming majority of food decisions still involve end users economizing on resources and providing quick feedback, etc. People mostly understand what they can do to reduce their food costs, and what the tradeoffs are, and obviously-inefficient providers are quickly spotted and competed away.

While not some kind of "pure" free market, it retains the basic form of one, where the government adjustments are the exception, not the rule.

In contrast, the government's role in health care is pretty much defining the system, and you don't have most of the market mechanisms that exist in health care: where people are "doing it wrong", it's not obvious at all, but hidden behind various layers people just accept as given.

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.

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.