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Health Care Interventionism: A Case Study /Mises.org-Artikel, engl.

verfasst von - ELLI -, 21.01.2003, 19:47

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Health Care Interventionism: A Case Study
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By Christopher Westley

[Posted January 21, 2003]

[img][/img] We
are often told that 40 million Americans lack health insurance, and that this
is a scandal caused by greedy health care providers in the private sector
constantly raising health care costs. This simply must be true because it is
told to us by Those Who Care.

Of course, there is much more to this story than the
storytellers let on. Many of the uninsured are uninsured by choice, and not by
necessity. Health care costs rise in response to providers trying to recover
losses emanating from government interventions into an alarmingly socialized
medical industry. (That prices tend to fall in industries marked by scant
intervention leads one to the conclusion that if"public servants"
really cared about helping the poor and sick, they would simply go away.)   

The truth is that this story is largely a myth promoted by
those who stand to benefit in some way by a bigger government. This explains
why events such as those that recently happened in my own state of Alabama
rarely receive media coverage.

Several years ago in Birmingham, a private initiative to
stem the flow of the uninsured to area emergency room facilities resulted in a
program known as HealthPlus. In this program, doctors would volunteer their
time and facilities to provide frequent emergency room visitors primary
medical care. The care would be less expensive than trips to the ER, and
unlike the ER, payments could be made on a sliding scale. Besides reducing the
burdens placed on local health institutions, HealthPlus would provide the
working poor an avenue through which they could receive the preventative care
necessary to reduce their future use of them.

It sounded like a great program, reflecting the efforts of
private individuals to try to deal with problems made worse by government
regulations, such as those governing the use of private ERs. It suggested some
of the ways that the working poor might be served by a free market in medicine
if one were ever allowed to come about. Its army of doctor-volunteers
underscored the notion that factors other than greed were causing health care
costs to spiral.

What's more, HealthPlus was geared to the segment of the 40
million uninsured that is most often invoked by medical socialists to justify
the U.S. government's adoption of a Canadian or British health care system. As
a result, HealthPlus attracted funding from the Robert Wood Johnson Foundation
for a three-year test.

However, one problem became obvious two years into the
program. Very few people wanted to use it. To effect a genuine reduction in ER
crowding, HealthPlus had to attract 3000 patients. After two years, it
succeeded in attracting only 500 individuals to sign up for the program, and
of these, far fewer kept their follow-up appointments at participating clinics.
Recently, the program was declared a failure and officials withdrew their last
year of funding totaling $150,000.

What happened? While focus groups showed that patients
perceived emergency room care to be of higher quality, they also showed that
patients considered the convenience of using the ER option more important than
the financial and health benefits that would result from utilizing
alternatives provided through HealthPlus.

Since programs such as HealthPlus have been successful in
other states in getting patients out of emergency rooms and into primary care
by offering medicine and doctor's visits free of charge to recipients, there
will most likely be an effort to resurrect the program with these benefits.

In truth, the demise of HealthPlus illustrates the
unintended consequences that accompany any government intervention of market
forces. In this case, federal regulations require private owners of hospitals
to provide health care to all comers. The intent is to create a medical safety
net to uninsured individuals in need of health care and unable to otherwise
pay for it.

Hospitals provide this service, but at higher prices than
they charge patients utilizing non-ER-using customers. Efforts to force
hospitals to reduce this price results in an overuse of these facilities by
the uninsured and a general increase of prices for all other consumers of
health care.

This result is completely congruent with economic theory in
general, and Austrian theory in particular. As Mises argued over seven decades
ago in his Critique
of Interventionism, such solutions inevitably lead to more
interventions in the future. By creating unforeseen problems, they lead to
more government programs to deal with problems that would not otherwise exist
prior to the initial intervention. As this process repeats itself, whole
industries can become effectively socialized. No one is happy with the results
save for the government bureaucrats charged with overseeing it.

This point is important to remember when policymakers
discuss providing free medical care to repeat-ER users in an effort to make
HealthPlus-like programs work as designed. Such efforts actually harm the very
people they are intended to help. While reducing crowding problems in the ERs,
other problems would arise, such as the creation of perverse incentives to
those receiving the aid to remain both uninsured and dependent on the fruits
of other's labor.

Moral hazard problems abound, as those receiving the
entitlement have little incentive to avoid unhealthy behavior. This solution
also further legitimizes the seizure of wealth and giving it to others—in
this case, of tax dollars going to doctors so as to allow recipients of
medical care to continue to pay a zero-price for it.

 In the process, both doctors and patients become
dependent on the expansion of medical welfare programs, thus making such
programs ends in themselves and providing reliable voting blocs for the
politicians that make them possible.

These are parts of the health care story that do not make it
into much of the mainstream press and they should be remembered the next time
you hear of the 40 million Americans who lack health insurance. One wishes
they were merely fairy tales. They can, however, have happier endings once
enough people stand athwart the system, and yell stop.

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Christopher Westley is an assistant professor of economics
at Jacksonville State University. See his Mises.org Daily
Articles Archive. Send him MAIL.

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Health Care Interventionism: A Case Study /Mises.org-Artikel, engl. - - ELLI -, 21.01.2003, 19:47