Julia B: Depends on the society + why is America so wasteful

[juliab]

My thoughts on the question "What degree of health care should society be expected to provide individuals?"

There is no right answer to this question as it stands, because there is no one right society that can be characterized by features like the degree of health care it provides its members. There is no one right society, and there should not and cannot be, because societies such as the one we live in are steeped in a heady brew of environment, history, belief systems, and myriad other features that distinguish one society from another. What can this mean for the question at hand? Perhaps it is the case that different societies are and should be expected to provide different degrees of health care to their constituents. It is worth considering whether you, whoever you are reading this paragraph, think this is an accurate description of the world: the expectation of how much health care a society should provide its constituents should depend on what society you are talking about.

If you do not agree with the above statement, and I can certainly see reasons why you wouldn't want to, then you're going to have to address questions not only of whether the US is failing where Canada is succeeding, but also whether historical societies failed to provide adequate health care. Did 14th-century Europe fail as a society for not providing adequate health care in light of the black plague? How can we expect tribal societies in historical Arabia or Israel to provide the same level of health care that we expect of our society today, when they existed well before germ theory, sterilization, vaccination, etc. were discovered? Perhaps you think there is a difference between comparing historical societies to contemporary ones, on the one hand, and comparing within contemporary societies on the other. But surely there are societies today whose medical knowledge and expectations are more similar to those in the historical societies than the contemporary ones--there are tribes on any continent (save Antarctica) that would fit this description. What of them?

These considerations are not meant to sway you one way or the other as to whether you agree with the statement at the end of the first paragraph. They are simply meant to make you think about what the question is really asking. When I read the question, my thoughts predictably led me down a path that said "Every society should be expected to provide individuals with the highest degree of useful health care that the society's economy and professional industry can provide." As a bleeding-heart liberal, my own considerations swayed me toward bemoaning all the wasteful health care spending in this country, and I wanted to make an argument that the United States should focus all its health care R&D attention and money on how to convince patients that they don't need and so should not get a $1000-plus MRI scan every time they bang their elbow on a doorframe. Then we could more usefully focus the efforts behind the billions of dollars spent on health care every year. But I realize the situation is not so simple as looking people in the eyes and telling them, you'll be alright without this $8000/year drug. And part of what makes the situation more complicated is the historical, environmental and social conditions that make members of a society members of that society and not another one.

So I started thinking, what about the United States makes its citizens more prone to wasteful health care spending than citizens of other countries? Because I think it is an American affliction, and the many radio shows and news articles and books I have used to get clear on the health care crisis have convinced me I am right. In particular, the health care special on PRI's "This American Life" tells beautifully the terrifying tale of wasteful health care spending in the US, and it is easy to see how it might not, could not happen that way in other countries or at other times. So, given that the particular kind of wasteful health care spending so prominent in the US right now is a uniquely American, uniquely now problem, should we take that into account when we ask what level of health care societies should be expected to provide? I think we should, and that has been the point of this long exercise in hypotheticals: to say that the expectations Americans have of their health care providers affect what level of care they can and should expect of a national health care program. And the fact that different Americans have different expectations--some expect their insurance companies to bill their masseuses, while others expect to wait for hours at the ER before getting their broken leg examined--is making it harder yet to say what Americans should expect from national health care.

I'm not sure how to resolve these complications, but I have convinced myself anyway--and perhaps you too--that it is hasty to say we should expect our health care system to perfectly mimic Canada's or Britain's or Switzerland's any time soon.