Health care systems kill people. So what?
As the debate over health care reform slogs on, a particular kind of argument has become quite familiar. It goes something like this:
Health care system X is a bad system because it kills people.
In support of this assertion, we are then treated to a set of anecdotes about how this or that person died as a result of this or that health care system break down. Hence, we see critics of Obama’s proposals trotting out horror stories about how NHS bureaucracy resulted in the death of this or that Briton’s loved ones. Likewise, we see supporters of health care reform unearthing heartbreaking stories of how the American patchwork of private insurance and Medicare or Medicaid killed off dad or mom. My question is, “So what?”
My point in this post is not to argue the merits of this or that proposal. I’ve got opinions on those things, but I’ll save them for another time. Nor do I want to create some kind of equivalence between all health care systems. America’s strikes me as exceptionally expensive and inefficient. Rather, I want to make a much simpler point:
All health care systems kill people. All of them.
They do this for three reasons. First, death is not ultimately preventable. We all die, although in the United States in particular we seem loath to acknowledge this fact let alone let it influence how we think about health care spending. Second, and perhaps more importantly for our purposes, things always breakdown. Even a system designed by smart people of good will will, for time to time, go horribly wrong and do something stupid. Unfortunately, this holds true in health care, where the stakes are high, and the forces of entropy and stupidity can kill. Finally, nobody has ever been willing to spend infinite resources to eliminate every preventable death. Every day we all engage in behavior that creates some non-trivial likelihood of death because the costs of doing otherwise are prohibitively high. Using automobiles is an obvious example, but a moments reflection will multiply them. The unvarnished truth is that we necessarily are willing to let people die preventable deaths.
As a result, I find myself unmoved by the stories of grandma killed off by the NHS or dad left to die by an insurance company. Health care systems kill people. So what? Can we start having a real discussion?