All Demand And No Supply In American Health Care Policy Debate

There is a lot of talk about access, so very little talk about increasing the supply of doctors and health care devices.

It’s open enrollment time, and as I worked on my forms for open enrollment, I took note of the differences in costs for each health care insurance plan. Yes, I have a day job, and as I surveyed the plans offered by my employer, I found that there were only two plans offered this year. Your employer may offer more.

I see that there is a PPO insurance plan, which is traditional insurance that most of us are familiar with. With a PPO, we have in-network and out of network providers with their corresponding costs. We have the discouragement enhancing copay, usually $20 a pop for office visits, and then we’re on the hook for 15% of the total costs for surgery and other big-ticket expenses. I guess the health care industry is worried that we’ll get an unnecessary triple-bypass operation just for kicks so they want us to ante up that 15%.

And then there is the health fund, basically, a very high deductible plan with healthcare savings account just for out of pocket health care costs, built into the plan. I’m on this plan now. I make a meager deposit to the HSA with every paycheck. My deductible is $7,000. That means, for any plan year, my out-of-pocket costs can never exceed $7k, and the insurance pays a very big chunk of my costs to begin with. With this plan, I can’t be bankrupted by medical bills. Maybe I could see $7k in medical bills for a few years in a row, but that’s unlikely. If my costs ever get that high, I don’t think I’ll be working.

I have the impression that this is the sort of thing that conservatives are promoting right now. You know, personal responsibility and all that jazz. They want us to be responsible for our own health while letting their business buddies pollute the environment and sell us stuff that will make our lives shorter, or at least, not quite as comfortable as it could be.

Even with Obamacare, I can see how this sort of conservative thinking has crept in just to get the original bill to pass. It seems to me that most of what is wrong with Obamacare, despite its popularity, is essentially sabotage on the part of Republicans jockeying to make it as unpalatable as possible.

But as I decided between traditional insurance, which isn’t terrible, and the health care fund, which has a certain gambling appeal, I couldn’t help but get the sense that conservatives on both sides of the aisle want to discourage the use of health care services, as if most of us have any control over that.

Yes, we can eat better, yes we can avoid vices like tobacco, sweets, dope, idling all day, and cocaine. We can even look both ways when we cross the street. But there are certain constraints on our lifestyle dictated by the people who write public policy. And most of us are not those people. It might even be said that a lot of our life is beyond our control.

Is there a politician honest enough to admit that all of the pollution emitted by business makes a great case for universal health care? Just think of microplastics. Mother Nature is not kind to plastic. The wind, the water, and the rocks, all break down plastic into little bits that are too small to see. That stuff is finding its way into the food chain, and eventually, into our alimentary canals. If someone gets sick from that, who do you sue? Where is the recourse? No wonder the GOP can hardly wait to do away with the EPA.

Yet, as I see how the private insurance system is set up to discourage the use of the health care system, I also see something else. See, the health insurance companies think about profits, and they think about shareholder value, so they think about reducing the utilization of benefits. But few if any health insurance companies or politicians are talking about increasing the supply of doctors and medical devices.

Conservatives talk a really good game about supply and demand, but it’s hard to find any conservatives, pundits or politicians, that are talking about increasing the supply of doctors. Seriously. Can you name one politician of any persuasion that is actively promoting policies that would increase the number of doctors? I certainly can’t.

In fact, I only know of one economist who is actively promoting policies that would increase the number of doctors (and dentists) in the United States: Dean Baker of the Center for Economic Policy Research. Just one. I don’t think I’ve ever seen any other economists talking about this idea. Did I mention how much economists love to talk about supply and demand?

I heard someone say long ago, that it’s easier to manage abundance than scarcity. Yet, the latter is exactly what we’ve been doing for a long, long time. We’ve been telling ourselves that we must get by on the current supply of doctors, no matter what. It’s like the scope of the debate has been purposely limited to demand, not supply.

No one in politics is talking about importing doctors. Sure, if we need more aluminum, we import it. But doctors? Are you nuts?

I saw this cool interview transcript posted on Naked Capitalism today. It’s a transcript of an interview of a former insurance executive, Wendell Potter. Potter has spent 20 years in the insurance biz, and in this interview, he debunks some of the biggest arguments Trump makes against “Medicare for All”. Well, Trump likes to call that, “Socialist Healthcare”, but Potter does a good job of showing us where Trump is wrong…I mean, being a salesman.

As much as I liked what Potter was saying, I could not help but notice that not a word was said about increasing the number of doctors in the United States. You know, if you increase the number of doctors to meet demand, the price for services provided by doctors is likely to come down. But that notion just doesn’t pass muster with the likes of CNN, NBC, CBS, ABC and FOX. You’d think this would be a big deal, right?

This isn’t an old argument. Mr. Baker was already talking about it in 2009, in his article, “Why Don’t We Globalize Health Care?”. I was blown away by what he was proposing:

There are clear ways to take advantage of lower costs in other countries, making our own system more affordable without diminishing the quality. We could allow more foreign-born doctors to work in the United States, for instance. We could encourage the “medical tourism” that allows Americans to have major procedures performed in other countries, and we could permit Medicare beneficiaries to buy into the lower-cost healthcare systems of other wealthy countries.

Wabam! Right there he has 3 good ideas for reducing the trade barriers that increase the cost of health care in the United States. You might want to read on in that article for more details for each idea. Now can you name a single politician in office or running for office that has promoted even one of those ideas? I can’t.

We need to expand the scope of the debate on health care costs. We need to look beyond the tired arguments that have been pounded into the sand for the last 10 or 20 years. We need to try something different. If free trade has worked so well for IT service, cars, and electronics, then it should work very well to reduce costs in American health care.

Free trade. It’s not just for consumer electronics anymore.

Write on.

Originally published at on November 8, 2018.

Husband, father, worker, philosopher, and observer. Plumbing the depths of consciousness to find the spring of happiness. Write on.

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