Public Roads And The Medical Revolution

The Medical Revolution has brought great improvements in health care and, like all revolutions, has altered the economic landscape. Our health care debate (as of September 2009) rolls on without discussion of this fundamental reason for change. Instead, the focus is on addressing the symptomatic problems: rising costs for employers and individuals, people without coverage, individual bankruptcy due primarily to a health catastrophe, over-treatment, complaints of un-reimbursed or under-reimbursed fees to providers. All are important, but symptomatic treatment will only be a temporary measure, introducing bureaucratic micro-management into our lives, inflicted either from a government or a private insurance company. One is hardly better than the other.

People have a right to live, and to be safe. But is there a natural right to wealth or to health? One might just as easily ask if there is a natural right to freely use a road or sidewalk. Roads are a good idea, they make trade and commerce easy. Once people began to live and to do business together, we found that we needed roads. Over centuries it has become clear that some kind of regulation in building and maintaining roads is a good idea. Everyone is allowed to use roads without restriction because getting a fee for every use is very difficult (except for limited access roads like bridges).

Having public roads makes everyone more prosperous. More business can be done if you have roads. That does not mean that government should always and everywhere build roads. In a shopping mall, the walks and roads are built and maintained by the a private company, the mall owner, and anyone may use these roads freely, suppliers and customers alike. We have determined that free road use is good and we worked out how to handle the cost details effectively.

Health has become a public concern because today there is so much more we can do to maintain health. That is the Medical Revolution. We want people to be healthy so that they can do their jobs (or care for their families or go to school). We want to have good public health so that pandemics are under control. Years ago (before the 1940's) few people had health insurance. In part, medicine was not as advanced. If you got a serious illness, cancer or accident the cost wasn't much of a concern because there wasn't much that could be done. Sadly, you would quickly pass on. In this respect we are better off today, much better off, but we haven't figured out how to organize the cost.

Society has changed many times. It changed when the Industrial Revolution had more people working in factories and offices than on farms. It has changed again recently when people may no longer work at one job all their lives. People are living and working until later in life. At each change we had to re-organize some things we never needed to before. That is part of progress. We have experienced a Medical Revolution, and some re-organization will be required

The fundamental reason to re-organize health care is to make everyone more prosperous. People must have the confidence to start a new business, to move from one job to another, to take a chance with a job at a small company instead of a big one, to go back to school if needed, to care for a loved one if needed, without the fear that they may themselves become ill and bankrupt.

Progress depends on widening the group of people who are willing to take a chance on a new opportunity.

But this doesn't necessarily mean a government provided system, it could be a mixture, just like the maintenance of roads and sidewalks.

It means a system that is well organized to provide:

• Routine care at affordable cost
• Complete coverage of catastrophic care to eliminate bankruptcy or privation.
• Care when you are not working or retired.
• Your choice of insurer and care providers.
• Complete portability: your coverage goes with you at the same cost, wherever you work.
  

In the same way we have organized ourselves to have roads that work, we should develop a health care system that works, and a way to pay for it that makes sense. Just like roads.

These are the objectives. Our policy should be to create objectives as a strategy, but not to try to manage how they will be accomplished. More on this in future posts.