Peter W. Huber has written an insightful and compelling explanation of how science is killing socialized medicine, no matter what our politicians may be saying now.
But we’re now past the days when infectious diseases were the dominant killers, and heart attacks and lung cancer seemed to strike as randomly as germs. And insurance looks altogether different when your neighbor’s problem is a persistent failure to take care of himself. Many people willing to share the burden of bad luck eventually tire of sharing the cost of bad behavior.The new medicine certainly hasn’t banished luck completely—molecules don’t predict car accidents and can’t yet cure Huntington’s disease, cystic fibrosis, or many rare cancers. A widely shared sense of common decency also impels protection of children and the elderly. In between, however, the unifying interest in health insurance is surely the sense that anyone can be struck out of the blue by a ruinously expensive health catastrophe. And step by relentless step, molecular medicine is taking luck out of the picture.
Now consider what that does to insurance economics. Most critics of the status quo focus on the more manageable of the two core problems that health insurers now face: runaway cost. But the real problem is that for many people, health care is getting cheaper. This is what makes actuaries wake up screaming in the night: disease is coming out of the closet, and the new medicine splits health-care economics in two. For the health conscious, skipping the Cherry Garcia may be difficult, but it’s cheap, and Lipitor at almost any price is much cheaper than a heart attack. The health careless skip only the pill, not the ice cream, and end up in desperate need of what helps the least and costs the most. Doctors, hospitals, and scalpels summoned late in the day cost far more, and accomplish far less, than chemistry tuned to the point where there’s never plaque to cut.
No one-size, one-price insurance scheme can keep people happy forever on both sides of this ever-widening divide. Aetna can’t offer uniform coverage to individuals who face radically different risks, and who know it, too. Governments can’t, either.
Medical advances have eliminated many of the health threats that all humanity had in common, and eventually the health-conscious will start refusing to be lumped in with the un-health-conscious and will refuse to continue sharing the financial burden for their last-minute health care.
Read to the end of the article for a good explanation of why government-regulated drug price ceilings stifle innovation and push health care costs up and quality down.
