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Jewish World ReviewDec. 3, 1998 /14 Kislev, 5759

Thomas Sowell

Thomas Sowell The health care "crisis"

SINCE VIRTUALLY EVERYTHING is called a "crisis" these days, perhaps we should not be surprised to hear about a health care "crisis." Still, those of us old-fashioned enough to believe that words should have some meaning may wonder just what this crisis consists of.

Are we getting worse health care than in the past? Worse than the rest of the world? Worse than we would like?

The answer to the first two questions is clearly "no." Our doctors today can cure or prevent diseases that were virtually an automatic death sentence in the past. People from other countries --- even rulers of some other countries --- come here for medical treatment, while few Americans go overseas to get medical care.

If our standard is whether we are getting worse than we would like, that applies to virtually everything, not just health care. I could be driving a newer, more powerful and more luxurious car. I would like to have a body like Arnold Schwarzenegger's, a brain like Einstein's and a voice like Pavarotti's.

While some things, like brains and voices, are gifts of nature, even these can usually be improved if we are willing to sacrifice the time to work on them. Other sacrifices, whether of money or time, can improve other things. The real problem is that we are not willing to make some of these trade-offs.

Fine. But don't turn it into a "crisis" because what you want has a cost. Everything has always had a cost.

Virtually every aspect of the so-called health care crisis boils down to the fact that everybody wants somebody else to pay for health care.

Health Maintenance Organizations have been criticized for getting mothers out of hospitals too soon after childbirth. But HMOs cannot force any mother to leave a hospital. They can only stop paying and let others decide whether it is worth the cost to continue staying. Alternatively, the HMOs can charge higher fees and cover longer stays after childbirth.

The basic underlying fact that is not going to change is that medical care is costly, whether those costs are paid by HMOs, the government, the patients or anybody else. We can try to pretend that these costs don't exist or hope to force somebody else to pay them, but none of that changes the costs or the fact that they have to be paid.

With our country's record prosperity, surely it is not too much to expect adults to face up to trade-offs. We are not talking about going hungry so that a child can have an appendix removed. We are talking about not eating out as often, or not buying so expensive a watch, so that a mother can spend another day or two in the hospital.

Politicians see all this very differently. They leave trade-offs to economists, who don't have to get elected. Politicians win votes by passing laws creating "rights" for patients to get this or that, without either providing any money to cover the costs or expecting the patients to cover the costs. The additional costs will be left to be paid "somehow."

It is a great game for those in the business of getting re-elected. But the costs don't disappear, no matter how much they are shuffled around.

When the government tried to shift the costs of medical care for the elderly onto HMOs, the HMOs started getting rid of elderly patients. Whether HMOs are good, bad or indifferent, they are just one way of delivering medical care. If there are better ways, people are free to find them. What is not free are more medical "rights."

How did we ever get into the present mess in the first place? There was a time when a patient simply went to a doctor and paid for treatment. The costs and the trade-offs these would entail were very plain to everyone. If it was worth it to get a broken arm fixed, but not worth it to go in every time you had the sniffles, then you made such choices accordingly.

Employer-paid "fringe benefits" began during World War II, as a way to get around government-imposed wage and price controls, when employers needed to hire more people but were prevented from attracting them with higher pay. Politicians found it expedient to exempt these benefits from the heavy taxes they put on money income. From this has followed the grand illusion of something for nothing, which has created needless problems in health care, as it has in so many other aspects of life.

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11/19/98: Tales out of bureaucracies
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11/12/98: Forward march
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10/09/98: Impeachment standards
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2/20/98: Dancing Around the Realities
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©1998, Creators Syndicate, Inc.