Take a Walk--and Try Not to Die---on the Supply Side of Health Care

[McCamy Taylor]

For years, the right has been harping on the idea of improving the supply side of health care in America. How do we achieve that?

Current health care laws and regulations discourage or prohibit cost-cutting, quality-improving innovation. Markets must reward innovators who provide services that consumers value, and these innovators must not face arbitrary punishment for taking reasonable risks.

http://www.nationalreview.com/corner/363410/obamacare-driven-supply-side-problems-veronique-de-rugy

In other words, if folks want snake oil, then the FDA should allow the market to supply snake oil and insurers should cover snake oil—and snake oil suppliers should not have to worry about pesky lawsuits. If folks want legal amphetamines and legal downers and legal euphoric agents, then the market should be free to provide them. If the market wants thicker hair and longer lasting erections, then that is where we should focus our health care spending.

What? You thought Idiocracy was a cautionary tale? A dystopian future? Silly health care consumer. It was a How to Manual for Supply Side Success.

“Reasonable risk.” What exactly is a reasonable risk? Depends upon whom you ask. The erectile dysfunction market supports the slaughter of African rhinos in its never ending quest for a longer lasting erection. Therefore, the erectile dysfunction market is likely to say that no risk is too great to get what it wants. That’s because consumers value a long lasting erection.

The diet market will go to any lengths to fit into a size zero. As a chronic dieter once said “I wouldn’t mind getting cancer if it meant I could die thin.” The diet market will accept any risk to get what it wants. Because consumers value being able to count each rib without actually having to live in a famine stricken country.

What do American consumers value? They want youth and beauty---and therefore a lot of people in Hollywood are on Human Growth Hormone and they periodically have to shave their Abe Lincoln chins. They want to live forever---but they also want to drink to excess, eat to excess, consume a combination of legal and illegal drugs to excess, brandish firearms without a clue about how to use a gun safely. And therefore, they want replacement hearts, lungs, hips, knees, ankles, livers for when the ones nature gave them crap out.

One supply side health care advocate insisted that health care costs would go down if the health care industry would only model itself after iPhone. To which I feel compelled to ask---is designed obsolescence something you are looking for when you get your hip replaced? Do you choose your new heart knowing that it does not quite fulfill all your needs but that’s ok, because next year surgeons will have the 2.0 version available?

If supply side health care was all about giving consumers what they need, it would be sensible health care. But too often, people---health care consumers---want something they do not need. And too often, health care providers want to make consumers want something they really do not need---because it makes the providers more money in the short run.

What makes health care supply side providers lots of money in the short run? Surgery. Patent medication. More surgery. More patent medications.

What does not make health care supply side providers lots of money in the short run? Diet counseling. Exercise counseling. As we gradually wean ourselves from our addiction to alcohol, we are killing ourselves with obesity. But there is no money in preventing obesity---and lots of money in treating it. Surgery and patent medications. And artificial hips and knees with the promise that if the person suffering from obesity can just get out there and exercise again, the pounds will melt away magically---never mind that the artificial hip is even less reliable than the natural one that got shot to hell from decades of carrying too much weight.

If your back hurts, you can easily find a surgeon who will take you to the operating room for a procedure that is just as likely to leave you will something called “Failed back syndrome” as fix you. What? You don’t believe me? Here’s the ICD 10 code for Post laminectomy syndrome. M96.1

Welcome to the Supply Side of Health Care. Enjoy your stay. If you are lucky, maybe you will still be able to walk once you get everything that the industry tells you that you want.

What is the alternative? A cradle to grave single payer program that emphasizes disease prevention . How does Western Europe achieve longer life expectancy and better outcomes at half the cost to consumers? A cradle to grave single payer program that emphasizes disease prevention. But disease prevention does not allow an investment banker to buy the patent on a crucial medication and mark the price up a 1000 times. Disease prevention reduces the market for that marked up drug. Disease prevention does not fill operating rooms. It does not sell artificial joints. It does not allow a medical school graduate to quickly pay off his loans and amass a fortune so that he can retire early---not the way that joint-replacement surgery does.

And speaking of joint replacement surgery, who has Trump selected to guide health care in this country for the next four years? A fierce advocate of supply side.

Mr. Price, an orthopedic surgeon who represents many of the northern suburbs of Atlanta, speaks with the self-assurance of a doctor about to perform another joint-replacement procedure. He knows the task and will proceed with brisk efficiency.

http://www.nytimes.com/2016/11/28/us/politics/tom-price-secretary-health-and-human-services.html

For those who have not (yet) priced a knee or hip replacement, they can set you or your insurer back $20 K to $60k depending upon where you have the surgery done.

That is 5 to 15 times the total annual per capita health care spending of Canada. Meaning if you just snagged a new knee , congratulations! You have just used up 15 years worth of health care! You truly are a successful consumer in the world of supply side health care. Now, don’t forget the other knee and both hips. There is no reason you should not use up 60 years worth of health care! Stimulate the economy! Make America great again for your orthopedic surgeon and your local specialty hospital and the company that makes your artificial joints. But if the new knee fails, buyer beware---supply side health care only works if you are willing to assume all the risks associated with your risky surgery. That means, do not go crying to a plaintiffs attorney if your knee breaks leaving you in a wheelchair----

And that is why health care cannot be compared to iPhones. If your iPhone is not the latest model, you can survive—no matter what your teenagers may claim. But if your heart or liver or knee is not working, you will suffer. Suffer horribly, in pain, perhaps in to the point of death. Your family will lose its provider and will plunge into poverty. Health is not optional. It is not a consumer choice. It is essential to life, like air and water---two other things which supply side providers will no doubt try to sell us in the future, for a profit.

Take a walk on the supply side? Dude, once the supply side is through with you, you will be lucky if you can crawl.