By Daniel R. Hoffman, Ph.D.
This week The New Yorker's financial writer, James Surowiecki, persuasively made the case (see here) that the single, most important basis for casting next Tuesday's presidential vote involves medications and health care in general. "Health care," according to Surowiecki, "is where the election's outcome will have the most immediate and powerful impact on how Americans live." Both the availability and cost of health care, including drugs, will vary enormously depending upon who wins the presidency.
On several occasions Mitt Romney has stated that on his first day as president he would try to either repeal Obamacare or render it inoperable. At a minimum that would eliminate subsidies for people to buy health insurance and allow insurers to deny coverage for people with pre-existing conditions. Romney prefers giving people tax breaks to buy insurance, effectively pushing them to obtain high-deductible policies. He believes this would make consumers more price-conscious in choosing treatments and doctors.
The underlying rationale of Romney's health care approach supposedly consists of "unleashing the free market," a process that will somehow improve quality and reduce prices. But this market fetish is a deceptively disingenuous fantasy. While the laissez faire approach may provide more choices and lower prices in sectors such as consumer electronics and packaged goods, it fails completely in health care. Health care is not and cannot be a market as a result of some stubborn facts.
First, markets work best when consumers can defer their purchases to wait for lower prices and more favorable benefits. That's not possible if someone gets into an automobile accident or if his doctor diagnoses a malignant tumor. Secondly, what economists call the "asymmetry of information" means most consumers lack the medical expertise and cannot learn the true costs and benefits of complicated care alternatives, thereby preventing effective comparison shopping. Finally, since extremely few consumers can pay out-of-pocket for serious medical care, most people will depend upon insurers and other, third-party payers. That means they will lose substantial control over what care they can buy and how much they will pay for it.
The idea of making people put more "skin in the game" by carrying high-deductible coverage is rightwing bull. Surowiecki points out that Americans already pay higher out-of-pocket costs than people in other advanced countries, yet our per capita health care costs are still two or three times higher. Besides, the Rand Corporation reported a massive study two years ago that showed while high deductibles and co-pays may restrain some people from pursuing excessive care, that sort of coverage also prevents more genuinely sick people from seeking necessary care.
In getting down to first premises, Surowiecki concludes that Romney's real intention isn't to lower health care costs. Instead he believes the Republican candidate wants to merely remove government from the country's health care system. According to Romney's "you're on your own" philosophy, government should not hold a core responsibility of helping to provide affordable, high quality health care. The real result of applying this reactionary market mythology to health care will be to make it a set of elective goods and services; people worth $250 million as a result of buying and looting companies can get the very best, while the rest of the country will get the shaft.
Surowiecki's argument is correct as far as it goes, but it begs the question of why a candidate who relied on government policies to amass his fortune and sought government financing when he managed the Olympics now wants to exclude it from an area of public life as important as national defense. The answer is quite simple. Removing government gives the game, by default, to the big insurers, the big drug companies and the other corporate entities that use health care for private profit. His core value lies in enlarging his fortune and those of his cronies. The nonsense of conservative economics is simply a fig leaf for cloaking the true purposes of this predatory ambition.
For those who believe the best role of government is that of handmaiden to corporate interests, their choice in the election booth next Tuesday is clear. Equally clear is the choice for people who believe health care and affordable drugs are a collective good that government should secure. May the better candidate win.