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Take each though below to its most positive and its most negative possible outcome.

I want health care for all. Therefore, the county government of Monroe County, NY is going to train, educate, license, etc. all doctors, nurses, cleaning staff, etc. The county government of Monroe County, NY is going to arrange all of the rules regarding creation of and sharing of electronic medical records. The county government of Monroe County, NY is going to establish all rules regarding monthly payments into the system by all users (even if usage is free), they will establish all policies regarding reimbursements to doctors and staff and facilities for all procedures, outcomes, tests, etc. that you can imagine. The county government of Monroe County, NY is going to contract for the building and maintenance of all medical facilities. The county government of Monroe County, NY is going to ensure that all food served in medical facilities is safe, tasty and local, and of course freely available to all medical patrons. The county government of Monroe County, NY is going to establish procedures for studying and evaluating the effectiveness of medical treatments, and following up personally on patient care. The county government of Monroe County, NY is going to be responsible for researching, developing and applying innovations in drug and other medical therapies. The county government of Monroe County, NY is going to be responsible for every and all aspect of the medical industry that you can possibly imagine.

OR …

I want health care for all. Therefore, one of the largest employers right now in Monroe County, NY, Wegmans, is going to train, educate, license, etc. all doctors, nurses, cleaning staff, etc. Wegmans is going to arrange all of the rules regarding creation of and sharing of electronic medical records. Wegmans is going to establish all rules regarding monthly payments into the system by all users (even if usage is free), they will establish all policies regarding reimbursements to doctors and staff and facilities for all procedures, outcomes, tests, etc. that you can imagine. Wegmans is going to contract for the building and maintenance of all medical facilities. Wegmans is going to ensure that all food served in medical facilities is safe, tasty and local, and of course freely available to all medical patrons. The county government of Monroe County, NY is going to establish procedures for studying and evaluating the effectiveness of medical treatments, and following up personally on patient care. Wegmans is going to be responsible for researching, developing and applying innovations in drug and other medical therapies. Wegmans is going to be responsible for every and all aspect of the medical industry that you can possibly imagine.

When someone indicates that they want, “health care for all,” it is hard to assess what, exactly that really means. Good economics starts here by asking, “at what margin?” Asking this question requires us to first define exactly what it is that we mean by “health care.” I am quite confident that I, Wintercow, can personally deliver “free” health care to every single American. How? Well, I am pretty sure I can take all of my life’s savings, and buy all of the Advil I can possibly buy with it, and have enough pills to give 1 single Advil pill to every man, woman and child currently living in America both legally and illegally. “But that’s now what I mean!” howls your companion. But saying, “I want to see everyone have health care” is a vacuous sentiment unless you articulate specifically what that means. For example, right now, given current tax and expenditure policy, every single “USER” of health care in America could have access to a virtually unlimited amount of 1980 quality health care, yet if you asked people if this is what they would want, they would surely so no as well. It is incumbent upon you to articulate just what you mean by “health care for all.” Second, the question requires we talk about “how much more” or “how much less” health care you are talking about. Just saying “we should have it” doesn’t help with the parameters of what that means. It can means lots of things to lots of people.

A couple of additional difficulties with the sentiment of “we should all have health care” include the fact that we are sort of making a huge assumption that “access to health care” means “going to the doctor” and further that going to the doctor improves health outcomes. Certainly 100 years ago that would have been a dubious position to hold. Despite our amazing modern knowledge of medicine, I find myself vaguely in that camp today, at current margins. Another problem with suggesting that everyone gets free healthcare is that someone has to provide it. Surely there are not enough dedicated people in the world to endure years of medical training and angry patients just out of the goodness in their hearts – so how do you encourage all of the nurses, doctors, researchers, etc. to become those things if you are somehow going to be providing it for free. Finally, what if the best way to expand access to medical well-being has nothing at all to do with the doctors? I tend to believe that one’s lifestyle choices make a huge difference on how healthy a life you live – and is it at least not reasonable to ask the question of whether dedicating trillions of dollars of spending to “medical care” is not best directed somewhere else in order to maximize the chance that people live health lives?

We are not here to break down the US healthcare “system” and whatever problems it may have, today, but remember, I do not know of a single person who does not wish that all human beings have the chance to enjoy better health outcomes. Saying “everyone should have health care” is a pretty vacuous shorthand for suggesting the former.  And blindly suggesting that everyone should have healthcare is making huge assumptions about who is going to provide such care, that accessing such care improves outcomes, that we know what kind of care you are talking about and that medical care is opportunity costless. Indeed, the sentiment that “we should have health care for all” is almost entirely incoherent. I recommend you see a doctor to get that corrected.

 

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