Romneys Health Care Fairy Tale

The Republican party has staked out such a fantasy based position on Health Care that it has allowed Obama to occupy the middle of the road where one can make decisions based on facts and data rather than having to cater to ideology.  

This is a bit of a problem for Romney, who is a pragmatic guy, as far as I can see.  He really wants Obama's job but has to be very careful about what he says to avoid irritating either his base who believe a fairy tale view of how good healthcare works, or the middle of the road voters who pay at least some attention to facts and data.

So the formula he has hit on is to avoid direct discussion of the realities of Health Care in favor calling Obama the "government" health care guy, and himself the "private sector" health care guy, and then piling up platitudes about how wonderful the private sector is at health care, and how bad government is at health care.  

If this turns out to be politically the best thing Romney can do, it will be because voters are to busy to realize how wrong this approach is, and it will limit Romney's ability to actually move the countries creaking health care system to a better place.  The historical evidence shows pretty clearly the private sector is pretty bad at doing Health Care.  At the end of WW II, when many Western industrialized countries were moving toward Government health care, Congress pushed the US into a system based on employers providing private insurance for their employee's.  Ever since we have maintained one of the most privatized health care systems in the industrialized world.

60 years down the road our health care system is a mess.  For decades, the cost of healthcare has inflated far more rapidly that inflation in general, to the point we now pay twice as much for healthcare per person as do citizens of any other country in the world ($15,000 a year in the US as against about $7,000 per year in the next most expensive countries).  Yet there are 30 or 40 countries where people live longer, another 30 or 40 where they have lower infant mortality rates.  And employers, the backbone around which our system was designed, are scrambling to get out from under the constantly inflating health insurance premiums.

The flaw in Romney's theory of healthcare is simple to spot.  A fundemental requirement to make a free market work efficiently is buyers who are not acting under compulsion.  When we go out to buy a car, if it is too expensive we just walk away, or go buy a used car, or a bike, or take a bus.  When enough of us just walk away the industry has to find a way to lower costs to survive.

We don't have those options with healthcare.  If we have a child with cancer, we can't just walk away until the price comes down.  In the purchase of medical services (by $ amount - healthy people don't use much health care - sick people use almost all of it) most of the buyers are acting under compulsion - the threat of serious debilitation or death.  So a key market force that controls costs is missing in a private medical marketplace.

Contradicting Romneys "Government is bad" position, we have an example of a government run health care system here in the United States that is far more efficient than the private sector medical providers, both in terms of cost per patient, and overall health outcomes.  The Veterans Adminstration Hospital system has no private component.

Many of those countries who spend less than half of what we spend per person per year have government run systems that their voters are very happy with,  (England, Canada and Sweden come to mind immediately) and their citizens live longer than we do and have lower infant mortality rates.

The Fairy Tale Romney is selling will have serious consequences if he is elected.  Even if he is just saying what he needs to say to get elected, he is boxing himself in.  The fundemental rule for Doctors is to "first, do no harm."  Romney will have a hard time even meeting this standard if he becomes President.