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Pittsburgh Tribune-Review: “Debunking ‘unaffordable’ health care”

In this May 9th, 2005, column in the Pittsburgh Tribune-Review, I dispute careless but familiar language used to stir up public antagonism toward the reliance on market forces for the delivery of health-care. You can read the entire column below the fold.

Debunking ‘unaffordable’ health care

Want to drive me mad? It’s easy. Just sermonize about problems using words and phrases that sound meaningful but, in fact, only create misunderstanding.

One of my favorite examples comes from the New York Times’ Thomas Friedman, who asserted, in his Thanksgiving Day 2004 column, that “half the country can’t afford health care.”

This statement is neither right nor wrong. A statement must be meaningful to be right or wrong. But this statement is meaningless.

Friedman writes as if health care is a well-defined thing that someone either gets or doesn’t get — sort of like pregnancy. You either are or you aren’t pregnant.

But health care, like most things in life, is not like pregnancy. It comes in an enormous range of degrees. At one extreme is the amount and quality of health care that Bill Gates might purchase — personal physicians and pharmacists, each devoted exclusively to Gates; monthly physicals conducted with the most advanced technology; immediate transportation in a private jet to the world’s finest hospitals for treatment by the world’s most acclaimed physicians; and recuperation at luxurious Swiss resorts attended round-the-clock by a staff of doctors, nurses and dieticians of unparalleled excellence.

Now imagine the opposite extreme — the case of someone who can afford no health care at all. This horribly unfortunate person would not only be unable to visit a physician to check out that runny nose or that blurry vision, he could not afford even to buy over-the-counter antihistamines, aspirin, cough drops, rubbing alcohol, hydrogen peroxide, reading glasses, Band Aids, athlete’s-foot spray, vitamins, toothpaste, condoms, or any of the many other health care and personal hygiene products for sale in every supermarket.

Almost all Americans, of course, consume an amount and quality of health care somewhere between the amount consumed by billionaires and the amount consumed by homeless paupers.

So when Friedman asserts that “half the country can’t afford health care,” I can make no sense of the claim because I have no idea what degree of health care he’s talking about. He’s surely right if he means that half the country can’t afford the kind of health care that Gates can afford. But he’s surely wrong if he means that half the country can afford no health care whatsoever.

Obviously, there’s vast territory between these two health care extremes. Going to see a general practitioner when your cold won’t go away, or going to the hospital emergency room when your child breaks her leg are in this vast territory.

Can half the country not afford such things? What about corrective eyewear? Or appendectomies, tonsillectomies, vasectomies and gall-bladder removals? What about prescription drugs such as Allegra, Nexium and birth-control pills? What about hospital stays for mothers giving birth? What about Lasik surgery? What about heart-bypass surgery? Heart transplants?

It’s undoubtedly true that as you travel the spectrum of health care opportunities — from over-the-counter aspirin all the way to heart-transplant surgery and beyond — you’ll reach some point of medical care beyond which the care is not affordable today by half the people in the country.

Where is this point? I don’t know. But nor does Friedman know where it is (even though he writes as if he does).

I do, though, have a solid guess: This point is well beyond routine visits to the family physician and purchases of even most prescription drugs. So Friedman’s claim that “half the country can’t afford health care” is a meaningless one that nevertheless conveys the distorted notion that 150 million Americans can’t afford ever to see a doctor.

The problem with Friedman’s statement is that it ignores the fact that almost all choices take place (as economists inelegantly say) “at the margin.” When we choose, we don’t choose all or nothing; instead, we choose “a little bit more” or “a little bit less.”

So it is with health care choices. None of us faces the choice to purchase either all available health care or absolutely no health care. Instead, each of us decides “at the margin” whether to spend, say, $100 on a visit to the doctor (“Is this cough really so bad that I shouldn’t wait a few days to see if it goes away?”). Likewise, each of us decides whether to spend $35 for a monthly dose of Claratin (“Is my stuffy nose so bad that I should spend $35 to clear it up?”)

Precisely because our economy is so productive and each of us is so wealthy, all Americans can afford levels of health care that were unavailable in past generations even to Rockefellers and Vanderbilts.


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