Saturday, December 20, 2008

The Concept of Health Care

What is health care? Well, let’s start with the basics. First, it involves the exchange of a products and services between buyers and sellers. Second, the health care industry employs an imponderable number of sellers including research scientists, physicians, insurance professionals, malpractice lawyers, allied health professionals, product manufacturers, educational institutions, hospitals etc. For those that are willing (or able) to invest in the requisite education, these are all good paying jobs. Third, our understanding of health care has been masked by a longstanding cultural tradition that obscures its economic basis. Much of the obfuscation takes place within our language: "buyers" become "patients," "sellers" become "providers," and "health care" becomes "whatever health care providers are willing to sell you." Thus, most of us believe that “health” is something that is provided by others and that we cannot be healthy apart from a "health care system." Similarly, the concept of “disease” has become synonymous with “needing” the products and services offered by the health care industry. So a state of disease is anything that attracts buyers to sellers. Modern medicine is based upon the ever-increasing malleability of the concepts of health and disease. Even if you believe that you are presently “healthy” you still might have an undiagnosed disease, a predisposition for a disease, an early stage of a disease, or a previously “cured” disease might be coming back. Therefore, in order to remain healthy you must maintain an ongoing relationship with a health care system and its legion of well-paid providers. One of the more striking features of the American health care has been the exponential expansion in the number of actual and potential “diseases” and “providers.” Today we routinely consult with “licensed” health care providers to lose weight, fight depression, quit smoking, break an addiction (drug, alcohol or gambling), have a child, not have a child, eliminate a potential child, or die peacefully. Critics of the American health care system argue that it provides too much and that it must be refocused on providing “basic health care,” which is even more malleable than the concept of “health care.” Basic health care is whatever politicians say it is. This means that in order to keep their good-paying jobs, providers must lobby congress and persuade legislators to officially decree that their products and services are “basic.” Fortunately, if we wait long enough, every health care product and service currently on the market will eventually become “basic.” But in a free market, the concept of “basic health care” is vacuous. It is a blunt political instrument that governments use to deny some individuals direct access to specific products and services. So what can we conclude about the concepts of “health” and “disease?” Libertarians prefer to let the free market sort that all that out. The first thing that the free market will do is help us sort out what actually works and how much we’ll have to pay for it. Viva Viagra!

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