Paying For Healthcare

Recently, a number of events have happened - both in the wider medical community and in my little bubble - that involve how we pay for healthcare. It's a difficult subject, one that elicits a wide variety of opinions and positions.

The Fundamental Dilemma

Much of the controversy on healthcare funding comes from a relatively simple conflict, derived from two widely-held positions.

1) We value health and life more than money when it comes to us or our loved ones.

2) We value money (in the form of lower taxes and insurance premiums) more than health and life when it comes to the vast majority of people we haven't met.

Basically we care about individual health more than collective health, but since the collective is made up of individuals, we get stuck between a rock and a hard place - constant pressure to reduce total costs along with constant pressure to increase individual costs. Since many decisions on spending get made on the patient- or individual-level where the pressure to increase spending is greater, it tends to win. Hence, ever-increasing healthcare costs.

Affordability

The catch comes that many individuals can afford to pay more for healthcare. When they have the option to do so for themselves (but not others) they often do so. In the US, you see this in luxury care for those able to afford it, and medical bankruptcy for those unable to afford it. In Canada, you see this in the push for a dual-tier system, where the wealthy would be able to pay extra money for more care than provided for by the public system. For those concerned with more equal access for individuals of all socioeconomic backgrounds, the push is more for increased taxes to pay for higher-quality heathcare for all.

Mo' Money, Not Mo' Health?

I work in healthcare. I would stand to benefit significantly if we suddenly spent more on healthcare, whether through a private, dual-tier system or through increased government expenditures. Yet, more money devoted to healthcare doesn't necessarily mean better health.

The Canada-US disparity in funding expresses this fairly easily. The US pays far more for their healthcare than Canada does, yet has overall health outcomes which are, at best, equivalent. Part of that is having great care for those who can afford it, yet very low-quality care for a group who cannot afford reasonable care. Fixing that disparity could push the US ahead of Canada in standard health metrics, but even so, not by all that much (and it might not even do that).

The thing is, that much money could have a real, meaningful impact on people's health - but not if it's spent in the healthcare system. The further into this field I get, the more I realize how poor many of our diagnostic tests and therapeutic interventions are. Some are incredibly effective, but many of a middling efficacy, while a few other may not work at all. There are some interventions that we know work really well though - these are improved diet, increased exercise, quitting smoking, reducing stress, longer/improved sleep, and moderating alcohol consumption. The healthcare system is slowly beginning to focus on these highly important lifestyle factors, but because they're part of a person's lifestyle, they're affected by much more than just healthcare services.

The difference in healthcare spending between Canada and the US is about 6% of GDP. If Canada decided it could afford to spend an extra 6% of its GDP on improving health - roughly $100 billion each year - I'd much rather see it go to efforts to improve those metrics that we know work. Getting people to eat better or exercise more has always been a difficult challenge, but with $100 billion each year, I bet we could come up with a few things that'd have an impact.

This brings me to my main point - there's a reason to control costs in healthcare, because healthcare isn't the same as health and it's certainly not the same as life. We want good healthcare and I want to be part of providing it. But I want good healthcare because I want people (including myself!) to be happy and prosperous. If the costs of healthcare hinder those efforts by minimizing spending on other worthy pursuits more than they help directly by improving health, it's not really beneficial. There are diminishing returns when pumping more money into healthcare, especially when that additional money doesn't have a clearly established, useful purpose.

Bottom line - controlling health care costs, whether public costs paid through taxes or private costs paid through insurance premiums and out of pocket, is an important goal, even for those who want the healthiest people possible.