Why Health Care Will Never Be Equal

New York Times: Why Health Care Will Never Be Equal Greg Mankiw

... Imagine that someone invented a pill even better than the one I take. Let’s call it the Dorian Gray pill, after the Oscar Wilde character. Every day that you take the Dorian Gray, you will not die, get sick, or even age. Absolutely guaranteed. The catch? A year’s supply costs $150,000.

Anyone who is able to afford this new treatment can live forever. Certainly, Bill Gates can afford it. Most likely, thousands of upper-income Americans would gladly shell out $150,000 a year for immortality.

Most Americans, however, would not be so lucky. Because the price of these new pills well exceeds average income, it would be impossible to provide them for everyone, even if all the economy’s resources were devoted to producing Dorian Gray tablets.

So here is the hard question: How should we, as a society, decide who gets the benefits of this medical breakthrough? Are we going to be health care egalitarians and try to prohibit Bill Gates from using his wealth to outlive Joe Sixpack? Or are we going to learn to live (and die) with vast differences in health outcomes? Is there a middle way?

These questions may seem the stuff of science fiction, but they are not so distant from those lurking in the background of today’s health care debate. Despite all the talk about waste and abuse in our health system (which no doubt exists to some degree), the main driver of increasing health care costs is advances in medical technology. The medical profession is always figuring out new ways to prolong and enhance life, and that is a good thing, but those new technologies do not come cheap. For each new treatment, we have to figure out if it is worth the price, and who is going to get it.

The push for universal coverage is based on the appealing premise that everyone should have access to the best health care possible whenever they need it. That soft-hearted aspiration, however, runs into the hardheaded reality that state-of-the-art health care is increasingly expensive. At some point, someone in the system has to say there are some things we will not pay for. The big question is, who? The government? Insurance companies? Or consumers themselves? And should the answer necessarily be the same for everyone?

Inequality in economic resources is a natural but not altogether attractive feature of a free society. As health care becomes an ever larger share of the economy, we will have no choice but to struggle with the questions of how far we should allow such inequality to extend and what restrictions on our liberty we should endure in the name of fairness.

In the end of our day of philosophizing, however, we face a practical decision:

Who gets the magic pills, and who pays for them?

Comments

[Travis Greene]

"Health Care Will Never Be Equal"

This is a straw man. Of course it won't. Neither will education. Who cares? Doesn't mean we aren't morally obligated to guarantee a certain minimum level of each, and it certainly doesn't mean that it's not in our collective best interest to handle both issues on a societal level.

We aren't talking about a total equalization of outcomes. We are talking about people dying of cancer because they failed to disclose a yeast infection, or diabetic kids having to re-use needles.

[Michael W. Kruse]

I don't think it is straw man but I do agree with you distinction. I think we need to find a way to take of basic health care cost in a cost effective way. Part of what dis driving up costs is the attempt to make very expensive procedures available to people who can't cover the economic costs. Mankiw is offering an extreme example to illustrate the the problem that is emerging. It is one piece, not the only piece, of the health care cost problem.