Health Care Bargains for Everyone on Your List

This article was originally published by Will Bunnett of the Rockridge Institute on November 21, 2007.

As thoughts turn from turkey to buying, it’s time to question conservative claims that health care is just another consumer good.

Thanksgiving is a day to connect with our families about what makes life great. And a day to watch the parade. And football. Ooh, and the Friday after is the first official shopping day of the Christmas season! Health care, like the holidays, should be about life and loved ones, but it too has been co-opted by consumerism. Just as we now associate holidays with family, football, and buying stuff on a very deep level, so we have learned to associate health care with insurance.

But thinking about the relief of suffering as a commodity to be bought and sold is absurd.

Special! Buy two gewgaws and get a knick-knack free! This year, we’ll once again shop for all the electronics, clothing, toys, and bric-a-brac that supposedly make our lives worth living. Holiday shopping has emerged as a popular stand-in for love, togetherness, and general human affection. But while we shop, why don’t we reconsider what it means to have health care? In many ways, health insurance has emerged as a stand-in for health care and well-being, conveniently missing that charging exorbitant prices and denying treatment don’t actually keep us very healthy. (See the Rockridge Institute’s paper The Logic of the Health Care Debate for a more detailed discussion of our different health care models.)

Sale! Pay for one emergency room visit and get your next amputation half off! Buy health insurance, then see if your condition is covered! What works for shopping doesn’t really make sense for health care. We don’t need all consumer goods equally, which is what makes markets an efficient way to deliver such goods. When it comes to well-being, we may have different conditions and illnesses, but we all have the same non-negotiable need to be healthy.

Talking about health care in economic terms is a typically conservative frame. Take conservative presidential candidate Rudy Giuliani, who got into the holiday spirit a couple months early when he weighed in on out-of-control health care costs and consumption:

“The free market operated, lots of consumers got into the market, they bought TVs, and manufacturers realized that if they reduced the price, they’d get more customers. How do you get health care providers to start thinking that way? The only way you do it is to have 70 million customers bring the price down and the quality up.”

Talking about TV’s is an exceptionally callous way of commodifying health care. At some point, you just need to be healthy, so the cost or marginal benefit (an economics term for additional gain) of a procedure or health insurance plan is meaningless. People can’t (and shouldn’t) choose health care the same way they choose TV’s.

Picture yourself shopping for a TV for your husband. You drag yourself out of your turkey-induced stupor on Friday morning to drive down to the mall, check out a few different models, and buy the TV that has the combination of price and features that will give your husband the most satisfaction per dollar. If you don’t find a TV that you think will suit him, maybe you buy him a new gas grill with that same money instead.

Economists think of this process of product comparison as a way to achieve “perfect knowledge” of the marketplace, and they call this typical shopping strategy “maximizing utility.” But these terms don’t accurately describe the process of choosing health care, where we never have perfect knowledge and are never in a position to maximize our utility. In health care, we have what we have and we need what we need; there is no room for trade-offs. Moreover, these cold, academic terms mask our true concern: the health and wellbeing of flesh-and-blood humans that we know and love.

Now picture your wife having a heart attack. The whole family is around the table, but no one knows what to do. You don’t have time to check out the features on different insurance plans or different types of emergency heart surgery. You can’t send the ambulance around to a couple different emergency rooms to see what they’re charging. If you can’t find a good deal on emergency heart surgery, would you buy her a gas grill instead?

A TV has value because it allows people to watch programs on it, so long as they are healthy enough to enjoy it. Health care has value because it allows people to lead full, satisfying lives with relatively little pain, suffering, loss of mobility, etc. Even if your husband ends up with a lump of coal in his stocking instead of a new TV or gas grill, life goes on. But if your wife doesn’t get her emergency heart surgery, life most certainly does not go on.

The value health care provides cannot be substituted for anything else. Health insurance, with its rationalist economic model of shopping and trade-offs, equates essential human needs with luxury commodities, just as holiday consumer culture equates love with buying. Putting health care into a consumerist, economic frame minimizes and distracts from its necessity to life. That frame is an affront to human dignity, compassion, and achievement.

To progressives, health care is a form of nurturance: it should be about our shared responsibility to take care of ourselves and those around us. (See The Logic of the Health Care Debate for more on the progressive and conservative understandings of care.) If it’s about our community and interdependence, it can’t be just about economic gain. That’s why the progressive conception is fundamentally incompatible with an insurance-based system for delivering care.

We would all be thankful for a system that sees health care for all as our shared responsibility, not a commodity. As long as we’re debating health care within the consumerist frame, we won’t truly get it. To make sure everyone on your list gets the gift of health, we need to dismantle our profit-first health insurance system.