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The High Cost of National Health Care

May 4, 2009
by James F. Pontuso

President Obama's claim that health care has become too expensive has struck a chord with the majority of voters. After many years of skepticism toward such a policy, going back to Hillary Clinton's effort to enact health care reform, many people now seem ready to accept Obama's cure for the spiraling costs of health care: a national health-care program.

It is amazing that the public debate over creating a national health-care program has been so one-sided and therefore uninformed. Perhaps this is true because sophisticated advocates of the national health-care idea have not told the public the whole truth, a truth that will make reform much less popular. The fact is that a national health-care system will not be free, as many in the public seem to believe. It will likely be more expensive than the current system and end up taking more out of most people's paychecks.

It is true that a national health-care system will relieve individuals of buying their own health insurance, but it will not lessen the cost of health care. Some one will still have to pay for the expertise of doctors, the skilled care of nurses, the cost of paying for sophisticated tests and treatments, and the staff to support all those activities. None of these things will ever be free, even if the government pays for them.  

The reason health care costs have risen is not because of waste, neglect, incompetence, or greed, but rather because medical care has become so much better.

A few personal examples might make the point. In 1953 my 38-year-old father had several heart attacks. After his first coronary my mother found one of the leading cardiologists in America to consult on his case. The doctor had an EKG machine - a diagnostic tool which had just gone into wide-spread use at the time - hooked up to my father the very moment he had another attack. The doctor's treatment was to take his device and leave the house. My father died a few weeks later. As I recall the doctor's visit cost $25.

I don't blame the doctor for my father's death. After all, what were his treatment options? He did not know about stints which open up blocked vessels, open heart surgery had not been invented, and there were no drugs to lower cholesterol or control heart function.

Everyone one of the life-saving procedures that might have saved my father's life cost money. Forty years later to the day after my father died, I had coronary bypass surgery needed because my arteries were blocked. I am still here today and thankful for an operation and treatment that saved my life and cost in excess of $60,000.

When I first had angina symptoms more than 16 years ago my family doctor sent me to a cardiologist for a test. During the test the cardiologist and I, an EKG machine and a treadmill were the four things in the room. The test stress test cost $297. This year - 2009 - I seemed to be bothered by angina symptoms again. My new, young, and very talented cardiologist had me undergo a nuclear stress test. First a nuclear dye was administered intravenously.  Then I was scanned by a complex device that took thousands of images of my heart. Next I went on the treadmill, this time with a lab technician, a computer technician, and a nurse overseeing the test. Finally I went back into the nuclear imaging machine with a different technician to see if changes had occurred to my heart function after exercise. My doctor tells me I am fine. The test cost $4500.

My cardiologist ordered the more thorough tests because she is good at what she does and given my medical history she wanted to be sure that she could accurately diagnose any problems. She did not order a more expense test out of greed. She is not living high or charging exorbitant fees so that she can join a snooty country club. In fact, she recently bought her first house. She is just emerging from under a mountain of debt incurred while in college, medical school, completing residency, and a cardiology fellowship.

Until she was 90, my mother never used either Medicare or her insurance. She was hardly ever sick until she suffered a stroke in 2007. Thanks to some wonderful doctors and nurses, she recovered from the stroke well enough to live on her own again with occasional home-care help. But she developed atrial fibrillation (rapid and irregular heart rhythms) and experienced a number of other medical problems. In the 18 months she lived after her stroke her medical bills amounted to over $250,000.

As I said, medical costs are rising because health care is so much better than it used to be. Although it is may not always be true, it often is: You get what you pay for.

Proponents of national health care insist that there will be reductions in administrative health-care costs. It is true that there are savings because of economies of scale, but has anyone ever seen a big government program administered efficiently?  Big government programs are almost always more expensive than expected exactly because bigness breeds inefficiency. A national health-care system in the U.S. may create the largest bureaucracy in the history of the world.

Advocates of national health insurance argue that preventive care is cheaper than trying to care for patients who have become seriously ill. This is true, but preventive care is more expensive than no care - which is what uninsured people usually choose. If we adopt universal health insurance, people who normally do not go to the doctor will go, and some one will have to pay for that care.

Moreover preventive care only delays serious illness, it does not eliminate it. People will live longer and old people get very sick and need lots of care, like my mother.

Social security insurance and Medicare have worked to provide more money and better health care for the elderly. But as a consequence old people live longer, collect more social security, and need more Medicare. Both programs have become vastly more expensive than was originally projected.

I am not suggesting that we let old people go hungry, cold, and uncared for. I take a great interest in the health of old people. I am one of them.

Nor I am I advocating that the poor be left with no medical care. As a rich society we may decide that universal health care is choice worthy. But we have to be honest; good health care will be expensive. So long as people want to live long lives and enjoy good health it will get more expensive as new and better diagnostic tools and more complex treatments are discovered.

There is another option. In order to keep health costs down, we can ration health care. We could decide that people as old as my mother should not receive expensive treatment or that I should get a regular old stress test instead of the fancier one. We could also invest less in new procedures and equipment. But again we have to be honest: less expensive health care will mean worse health care.

We could also reduce health care by capping the compensation for doctors, nurses, and other health care professionals. But we have to wonder whether the nursing shortage in the U.S. would get worse if nurses' pay were lowered. As for my cardiologist, she loves medicine and she might have pursued her career even if it took her longer to pay off her debts. I know she is talented enough to succeed in most any profession she entered. Like most people who are really good at what they do, she wants to be compensated for all her hard work, dedication, long hours, and expert skill - such, after all, is the American dream.

The cost of national health care will be high either because good health care is expensive or because inexpensive health care will not be good. This is the issue which we face.
--------------------------------------------------------------------------------- Contributing - James F. Pontuso is Charles Patterson Professor of Government & Foreign Affairs at Hampden-Sydney College in Virginia. He is author of numerous scholarly articles, reviews, and essays.  He has written a number of books including Vaclav Havel: Civic Responsibility in the Postmodern Age.

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