Keith Hennessy Only Asks Part Of The Health Care Reform Question

Over at his own blog, Keith Hennessy poses a flawed question: Who should decide whether additional medical care is worth the cost?

Unfortunately, cost is not the only, or possibly even the main, point when it comes to health care.  It it were, the debate would be easy to settle with a strictly financial calculation.

Using one of Keith's hypothetical examples, the high-cost new treatment for a broken wrist would make sense if for some reason the community wants, needs, and values the person receiving the treatment back using his or her wrist as soon and as well as possible.  That means that being in a cast for six weeks might be physically uncomfortable for most people but woudl also make financial sense unless they were the starting quarterback of a team about to play in the Super Bowl.  It probably wouldn't make sense for a college professor, but absolutely might make sense for a bus driver, especially if there were no other drivers available to fill in and people wouldn't get to work or school (or be able to go shopping).

(Or to make this very personal...it might make sense for a blogger whose daily posting you can't live without, but no sense at all for a different blogger whose opinions and sense of humor you have no use for whatsoever.)

Much of this depends on who is paying the bill for the additional medical care.  The person who has broken his or her wrist will almost always want the faster and better treatment because that's what's important to them.

And if they're paying for the treatment, they should be entitled to get it.  But as soon as they are paying only some -- or none -- of the cost either because of an insurance plan or a government program, the value of the treatment and, therefore, the decision, starts to be shared with someone else.  Whether it's an insurance company or a government agency, what's important to this other party may well be very different from what the wristbreaker would decide.  They might not care about whether the quarterback plays or the driver drives if it means that stockholders will be worse off.

And that's the part of the question Keith didn't ask.  The real issue isn't the cost of the care, it's how do we determine the value to the payer of of providing the care.

This is what makes the health care debate so difficult.  Financially the decisions are relatively easy.  Morally, ethically, emotionally, and, therefore, politically, they are virtually impossible.  This is what allows the phoney issue about death squads to be raised and to be contrasted with the primarily financial debate over generic drugs.

Keith said in his post that he's going to follow up this first with a second.  Let's see if he adds the non-economic aspects to his discussion and makes it far more useful in the process.