Montreal, October 15, 2009 • No 271


Gennady Stolyarov II is a science fiction novelist and philosophical essayist, and is Editor-in-Chief of The Rational Argumentator. He lives in Carson City, Nevada.




Commonly Misunderstood Concepts: Health Care


by Gennady Stolyarov II


          It is an odd society indeed where such a seemingly simple idea as health care is so severely misunderstood. Health care, as the constituents of the term suggest, is simply caring for one's health, where health—of course—is the physical integrity and unobstructed functioning of one's body. A healthy person is one whose body is not breaking down, one who is not in constant pain, one who is going to live for a long time unless some unforeseen external peril—such as an accident or an assault—violates the integrity of one's body from without.


          In a society where there exists advanced scientific medical knowledge, it is possible to benefit one's health by consulting with certain individuals who specialize in aspects of this knowledge. These individuals are also useful in detecting diseases or other malfunctions that are not obvious to the intelligent layman, and they also do a commendable job in researching cures for diseases that have hitherto been without remedy. Most doctors are to be praised for the excellent work they do, and I am confident that any doctor worthy of his M.D. degree would strongly concur with the fundamental understanding of health care that I posit here.

          Most people will recognize that doctors play an important and sometimes necessary role in the provision of health care. What many people today fail to recognize, however, is that doctors are never a sufficient part of genuinely effective health care. Doctors can indeed often detect signs of illness and recommend remedies, but to expect a doctor to perform all of your health care for you is just like expecting a teacher to perform all of your education for you. Doctors and teachers can both help and can even at times make the difference between success and failure, but without your participation and your vigilance, failure is inevitable.

          What are other crucial components of health care? They are not esoteric, and they do not require specialized knowledge. They include eating in moderation, exercising regularly, avoiding harmful substances, practicing at most monogamy, keeping one's surroundings clean, and avoiding risks to life and limb as much as possible. There are also numerous over-the-counter medications and first aid practices, that, if used intelligently, can enable individuals to recover from many minor and even some major perils. These habits are not just little frills added on to the body of health care; they are that body, and without them, one will be quite dead quite soon—but not before racking up absurd amounts of medical expenses. I will note that in the 20th century, human life expectancy in the West surged from the mid-to-late forties to the late seventies. Although medical advances were phenomenal during that time, the vast majority of the increase can be attributed to improvements in overall cleanliness of infrastructure and healthier habits. With the advent of sanitation, regular dental hygiene, automatic washers and dryers, and efficient household cleaning supplies, a lot of infectious diseases that formerly wiped out millions were kept at bay—mostly not by doctors, but by ordinary laypersons living their lives in a superior manner to that of their ancestors. New technologies motivated new behaviors, and these everyday behaviors are our first and so far our best line of defense against disease and decay.

          Of course, some people who lead their lives in the most health-conscious manner possible can still be afflicted by catastrophic diseases for reasons that are none of their fault. As far as medical science is aware, many cancers do not appear to be caused by any active human behavior; indeed, some are an unfortunate product of poor genes. And, of course, there is the ultimate killer—senescence—which afflicts all humans, given the current level of medical technology. It is imperative that these perils be eradicated as soon as possible, and the best doctors, scientists, and media advocates are needed to enable a victory over what can justly be called the greatest threats to humans everywhere. I will add that it is a matter of justice that a person who suffers from a disease which he did not cause receive prompt, efficacious, and affordable care. But the vital question—and the question many people today neglect to consider—is how this just state of affairs can possibly come about.

          Reality only works in certain ways, in accord with immutable natural laws. Wishing for a good outcome will not make it so, and even acting toward that outcome will only work if the right actions are undertaken. Any reasonable, moral person will agree that it is preferable for all reasonable, moral people to be healthy rather than not. What many people fail to recognize is that any process of improvement takes time, and that surrogate measures that attempt to bring about the improvement instantaneously are not only illusory but can also be severely counterproductive.

"To expect a doctor to perform all of your health care for you is just like expecting a teacher to perform all of your education for you. Doctors and teachers can both help and can even at times make the difference between success and failure, but without your participation and your vigilance, failure is inevitable."

          As a case in point, I bring forth the oft-encountered contemporary confusion of health care with health insurance. Too many people today believe that it is not taking care of oneself and visiting doctors when necessary that constitutes good health care, but rather the presence of health insurance, which—at least in theory—promises to pay for some of the medical attention one receives from doctors. These individuals see statistics stating that millions do not have health insurance, and they mistakenly assume that these individuals do not have adequate health care. But it is entirely possible for a person to have healthy habits and—especially if this person is young—to not require extensive or expensive medical attention. It is also possible for a person to be sufficiently wealthy to afford to pay for the doctors he wishes to visit. Moreover, it is possible for a person to rely on the charity of doctors in providing any medically necessary attention—as was the case for centuries before health insurance came about, when most doctors would treat all patients but would charge them differential rates based on their ability to pay. In effect, with these traditional doctors, the rich voluntarily subsidized the poor on a largely free market, in a manner beyond the wildest dreams of the advocates of socialized medicine today.

          Of course, the presence of health insurance cannot avert the need to seek the attentions of doctors. Indeed, a well-known concept in insurance, moral hazard, suggests that in some cases, an insured individual may actually be more likely to fall victim to a peril than an uninsured individual, because the insured individual is shielded from some of the financial consequences of the loss. Insurance can make life easier for some people in some cases, and it can also be a good safeguard for catastrophes, but it is neither necessary nor sufficient for proper health care. Indeed, the manner in which health insurance has developed in the United States is one of the contributing factors to the astronomically increasing prices of specialized medical care. Health insurance in the U.S. is not provided on a largely free market like most forms of property insurance. Instead, it is mostly tied to one's employment by virtue of the market-distorting tax breaks that employers receive for providing health insurance. One does not need to worry about what happens with one's car insurance if one loses a job, but losing one's job can severely damage one in the realm of health insurance.

          Since employers began to receive favorable treatment from the federal government for providing health insurance in the 1940s, the health insurance snowball has continued to embroil more people in a crisis of increasing proportions. The people who got the subsidized insurance had an incentive to spend more money than they usually would on doctors—often an outcome of hypochondria rather than of a reasonable concern for health. As demand for medical services rose, so did the cost, and so the people who did not have insurance—especially the elderly and unemployed—found it more difficult to afford even basic services. The federal government's solution? Medicare and Medicaid, which put the elderly and unemployed in the same position to spend more freely that the previously insured had. This, of course, further increased the demand for and price of specialized medical services. With the recent vast expansion of Medicare under the Bush administration, it is no surprise that prices have further skyrocketed.

          Now, because so many people have subsidized health insurance, it has become extremely difficult to afford medical care for catastrophic situations without it. This is not a necessary component of health care in a quasi-advanced society; it is a creation of bad policies that incrementally expanded the scope of the present crisis. An even worse policy is on the horizon; it is not socialized healthcare yet, but in some respects it may even be worse. The Obama administration and its supporters in Congress threaten to require everyone to purchase health insurance and to eliminate the aspect that makes it insurance—selection and pricing on the basis of the risks posed by the insureds. Forcing people to purchase health insurance and prohibiting discrimination on the basis of pre-existing conditions are the same as making the healthy subsidize the ill and charging everyone roughly the same general rates. With this kind of incentive system in place, it is only logical to assume that many people who otherwise would have lived spectacularly would begin to demand medically unnecessary attention simply to be net beneficiaries of the system where everyone ostensibly subsidizes everyone else. This cannot continue indefinitely, as resources are finite, and the inevitable recourse by the government will be the rationing of medical services—a political selection of who lives and who dies. This scenario—so common in many countries in the West today, including Britain and Canada—is the opposite of genuine health care. Indeed, denying care to an individual who could afford it and placing that individual on a waiting list on which he dies is nothing short of murder.

          Only a massive shift in public opinion and government policy can extricate us from the entanglement of health care with health insurance and return us to the direct relationship between patients and doctors, as well as the optimal amount of motivation for each individual to care for his own health. Until then, stay healthy and try to make sure that you do not need the care that gets rationed—if you can.