Saturday, April 19, 2014

The Road to a Geriatric Holocaust and How to Get Off It: Reisman's Comments on New York Times Article "Cost of Treatment May Influence Doctors"

On April 18, the National (print) edition of The New York Times published a front-page article titled "Cost of Treatment May Influence Doctors." The article reveals a growing acceptance in the medical profession of the belief that it is proper for doctors to practice medicine with only one eye on the patient because the other eye must be attentive to the impact of the patient’s treatment on the government’s budget.
Comment 1at   

Prior to WW II, the principle operative in medical care in the United States was essentially that a patient was entitled to all the medical care he could afford to buy from willing providers. Lack of ability to pay could be made good only by private charity, often provided by doctors and hospitals.
Starting in WW II, with the government’s exemption of employer-provided medical insurance from wartime wage controls, the principle became ascendant that a patient was entitled simply to all the medical care he needed, without consideration of his ability to pay.

Now, it appears, we have come full circle, and the ability to pay is once again to be an essential element in the provision of medical care. Only now, it is not the individual’s ability to pay, but the State’s ability to pay.
This is a very dangerous situation, for it means that it is now up to the State to determine who lives and who dies. It is particularly dangerous for the elderly.

If one looks at medical care for the elderly from the perspective of the government’s finances, it is obvious that their care is a major expense to the government, while their limited ability to work prevents them from contributing very much in the way of tax revenue.
The horrifying truth is that we have created a situation in which the government’s finances would be improved to the extent that the elderly simply did not receive care, and further improved as they then died off, which would reduce the government’s Social Security payments.

Comment 2 at
The ever-rising cost of medical care certainly does need to be restrained. But asking doctors to treat patients with one eye on the government's budget is not the way to do it.

Medical care can be made more affordable to the extent that the supply of it can be increased, while the demand for it is decreased. We can increase the supply of medical care by abolishing or at least greatly liberalizing medical licensing requirements. We can reduce the demand for medical care by eliminating as far as possible the interference that makes it appear to be costless to the individual or far less costly than it actually is.
It is true that if medical licensing requirements were reduced, less capable people would be performing tasks that today only more capable people perform.  That would be the medical equivalent of an automobile market in which people are allowed to buy not only a Cadillac or a Lexus, but also a Chevrolet or Toyota. We need to open up the medical market to competition, particularly at the low end.

The cost of drugs could be reduced by opening up their production to competition—from imports and from new drugs. The latter could be accomplished by sharply reducing the FDA's power to restrain the introduction of new drugs.