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Reflections

Ailing Health Care

by Ralph R. Reiland,
Professor of Free Enterprise

In his "The Moral-Hazard Myth" article in the February 7th issue of The New Yorker, Malcolm Gladwell points to what's wrong with the American health-care system, starting with the economics on the family level: "The leading cause of personal bankruptcy in the United States is unpaid medical bills. Half of the uninsured owe money to hospitals, and a third are being pursued by collection agencies." Worse, of course, than getting collection calls from India is being dead.

"Children without health insurance are less likely to receive medical attention for serious injuries, for recurrent ear infections, or for asthma," writes Gladwell. "Lung-cancer patients without insurance are less likely to receive surgery, chemotherapy or radiation treatment. Heart-attack victims without health insurance are less likely to receive angioplasty. People with pneumonia who don't have health insurance are less likely to receive X-rays or consultations."

The result? "The death rate in any given year for someone without health insurance," reports Gladwell, "is 25 percent higher than for someone with insurance."

There's a Catch-22 in all of this. As Gladwell explains: "Because the uninsured are sicker than the rest of us, they can't get better jobs, and because they can't get better jobs, they can't afford health insurance, and because they can't afford health insurance, they get even sicker."
It's like that when I go to the pharmacy for a prescription. The price is $31 because I have good insurance, a good job. For the guy next in line without insurance and a bad job, the price for the same pills jumps to $159.

The system, in short, charges the most to those who can least afford it (with less dire consequences, it's the same at the movie theater -- non-struggling and "over-55," we pay $5 per ticket while the poor high school kids in line behind us, without a dime in the market, pays $8).

It's also a system that isn't cheap, even with 45 million people without any insurance, the regular refusals by insurance companies to authorize treatments, the drive-thru mastectomies, and the skipping of crucial check-ups and medical care by the uninsured. "Americans spend $5,267 per capita on health care every year, almost two-and-a-half times the industrialized world's median of $2,193," reports Gladwell. "The United States spends more than a thousand dollars per capita per year -- or close to four hundred billion dollars -- on health-care-related paperwork and administration, whereas Canada, for example, spends only about $300 per capita."

What matters most, however, is that the U.S. medical system simply isn't there for millions of people when they desperately need it to save their lives.

Dr. Sanjay Gupta, assistant professor of neurosurgery at Emory University Hospital, chief medical correspondent at CNN, and a practicing neurosurgeon at Grady Memorial Hospital, reported recently on the story of Mark Windsor.

"Mark tells us a very important story," states Gupta. "He reminds us that being uninsured in this country not only means the loss of a safety net, incredible anxiety and possible bankruptcy. It could literally cost you your life."

Gupta explains: "When Mark was 27, he learned he had cancer and doctors operated on a large tumor in his neck. At that time, he had insurance and was able to get the operation. Thinking he was cured, Mark pursued a passion of his -- photography. In the process, he lost the insurance he had through his job. And, the cancer came back."

And that's how it ends. The cancer comes back and this time a man can't be helped because his paperwork isn't right, his premiums aren't paid.

"Now uninsured, Mark was slowly dying," Gupta reports. "At first he found doctors who would do his operations for free, but that lasted only so long. He was not eligible for potential lifesaving treatment because of the expense -- hundreds of thousands of dollars. Now his doctors are convinced he will most likely have an abbreviated life. In a desperate measure, Mark married a woman who was simply a good friend, at least so he could get insured. It may be too late. His cancer has spread to his lungs."

The cancer has spread to his lungs, and here in Pittsburgh we've broken ground for a new $435 million subway tunnel -- a mile long, a tunnel to nowhere. And there's not enough money for chemotherapy.

Said Thomas Jefferson, "The care of human life and happiness, and not their destruction, is the first and only object of good government."

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Ralph R. Reiland is an associate professor of economics at Robert Morris University in Pittsburgh.

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Ralph R. Reiland
Pittsburgh, Pa. 15236
Phone: 412-884-4541
E-mail: rrreiland@aol.com

"Ralph R. Reiland is the B. Kenneth Simon Professor of Free Enterprise at Robert Morris University, the owner Amel's Restaurant, and a columnist with the Pittsburgh Tribune-Review."