Amazingly, not intellectually honest

There is this lovely dream that if only we waved our magic wands in the right way then health care for all would be cheap. The thing being that health care costs money to provide and it’s just never going to be cheap, whatever system we use to try and provide it. Sure, we can say that it will be cheaper using some methods, cheaper than others, but that’s not the same thing at all. All of which leads to this lovely stuff from the World Health Organisation:

Millions of people worldwide face financial ruin; their assets wiped out because of a catastrophic illness or accident that saddles them with staggeringly high health bills they are unable to pay.

This nightmare scenario rarely, if ever, occurs in countries that have universal health coverage. Such systems insulate people from the financial disasters that occur in countries where national health schemes do not exist.

“Today, about 100 million people fall into poverty because of health expenditure,” said Rudiger Krech, World Health Organization director for health systems and innovation. He told VOA that every country, poor and rich alike, can afford universal health coverage.

“It is not just a matter of money, but of political will, of political choice. So, you can afford health coverage for everyone, even if you are not one of the most affluent countries in the world,” he said.

No, that’s idiocy. You can’t afford, say, leukaemia treatment for all who need it if you’re a poor country. You can afford polio vaccines for all, but not advanced catastrophic coverage. In a place where annual incomes are $600 a year – DR Congo perhaps – even that vaccine program’s going to be tough to reach without outside intervention.

But this gets worse:

For example, he said that relatively low-income countries such as Cuba and Costa Rica have developed good health systems

Anyone who thinks that Cuba’s health care system is OK is not just being an idiot he’s lying. But worse again:

The World Health Organization reports at least half of the world’s population lacks full coverage for essential health services. More than 800 million people, or nearly 12 percent of the world’s population, spend at least 10 percent of their household budgets to pay for health care, WHO said. In 2015, it said the world spent an eye-watering $7.3 trillion on health, representing close to 10 percent of global Gross Domestic Product.

And there’s the ignorance to add to our list. GDP is, by construction, everyones’ incomes. So, if health care is costing 10% of the aggregate incomes of all then quite clearly there are going to be some people paying 10% of their income in health care costs. Like, perhaps, 100% of the people. Which accords not too badly with reality actually – the NHS costs £2,000 to £3,000 per person per year, average incomes in the UK are £20,000 to £30,000 per year and that’s just among those employed, leaving aside the 50% of the population that doesn’t work.

Shouting “Make the government pay!” doesn’t change this basic fact, that health care costs money and that there’s only us chickens here with money to pay for it.

Now, there is a sensible manner of organising health care cost distribution. There are those catastrophic costs that might – note, might – arrive and these are best dealt with through some form of insurance. Could be private sector insurance and no, that’s not the part of the American system which ails it. We could have insurance though taxation and government financing, that certainly happens. But there’s also routine health care which isn’t best dealt with through an insurance based method. Which also means that it’s perhaps not best dealt with through taxation and governments. Or that we might want to not have free at the point of use provision of it at least, even as we do make catastrophic treatment so.

That might guide us to the Singapore system, compulsory savings accounts for routine care, government run catastrophic health care insurance. This is, by chance or not, the world’s cheapest decent health care system too. Producing results akin to the vastly more expensive American one at about one quarter the cost as a percentage of GDP. And no, amazingly, the WHO bod isn’t recommending that Singapore system.

The real problem here is the abuse of language. Sure we want universal health care. The argument isn’t about that at all, but about how to structure and finance that – how do we make sure that all gain access to health care universally? But that’s not what “universal health care” is taken to mean in these conversations, instead it means “government run and paid for health care” which is a very different thing.

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“Millions of people worldwide face financial ruin…because of a catastrophic illness.” Okay, go back a century and each of them would have simply died because of it. Remaining alive but with daunting bills to pay is not a pleasant situation but it is a big improvement. Old people used to have failing vision and failing hearts. Now the only daunting thing is paying the bill. Decades in the future, these catastrophic illnesses will become routine to treat, and activists will be hand-wringing about a smaller minority with more intractable conditions. Old people facing doom will approach but never reach zero,… Read more »