Healing the Sick

Michael Moore’s Sicko, whatever else it may be, provides a great illustration of the sticking point of the idea of a market for health care. One of the early scenes is a story of a man who, having the tips of two fingers severed by a table saw, is given a price for attaching each fingertip. He opts for the less expensive (and less damaged) ring finger and leaves the middle finger about ½ inch shorter. Really, from the standpoint of classical economics, this is the ideal scenario: He was given an explicit option between alternatives and allowed to place a value (in this case how much debt he was willing to incur) on the “good” of each fingertip. Most people don’t get to make such clear, rational decisions about their health care in extreme situations.

Yet, to many, if not most, people, the whole situation is morally reprehensible. The idea that there existed a way to make him whole again, it was within reach, and would not harm (other than opportunity cost – which may be the key,) anyone else to perform just screams of a moral duty to perform. The idea of negotiating over a part of someone’s body just seems monstrous. The rational arguments are all there: someone spent time and energy developing the technique and deserves to be compensated; an expert surgeon would be required to spend time and skill he spent years developing; the overhead costs of the hospital and operating theater need to be maintained so they’ll continue to be there; and a dozen others. Still, there is something about the entire matter that screams violation back though the recesses of the primitive brain and refuses to let anyone sleep at night, regardless of the utility equation. The most basic things within us are shouting, “good can be done, good must be done here.”

This is the problem (well, one of them) with the entire matter. Unless people are willing to accept that decisions considered cruel and inhuman can, will, and must be made; unless the public at large is willing to accept going back to Victorian attitudes of the justice of misery and suffering; then a true market for health care can not exist. Free exchange requires an option to walk away. Period. Anything else is not a market. It may be a pseudo-market hybrid, it may be a competition-restricted option to dole out a tax credit to six or seven different corporations, but it will not be a free market.

Indigent care remains the ignored thousand-pound gorilla in the room that serves signal for the entire system. It is not obligatory to convert every hospital to a single-source system administered with government funds (taken, of course, by force – a form of moral transgression in its own right,) but is a half-way part-way maybe system a better alternative? Federal programs already make up for an enormous portion of the medical dollar, and often those not covered are tasked to make up the profit shortfall of the government system. Would it stifle innovation? Maybe. Would it discourage so many from entering the industry? Sure. Is this a circle that can’t be squared? Quite possibly.

However, until it’s looked into the eye with something other than facile, milquetoast reasoning it’s only going to get worse.

Compare: Socialized Medicine?


N.B: Slate’s Dana Stevens had a great observation about the film: Hasn’t Mr. Moore’s arch-nemesis General Motors essentially bankrupted itself paying for healthcare? The irony.