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
http://nyti.ms/1ngD4JY:
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.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.
