Capitalism brings Americans an abundance of products and our mindset is very clear. When it comes to purchasing we want everything good, fast, and cheap.
Think about it.
- We want high quality—good.
- We want it readily available—fast.
- And we want it affordable—cheap.
But there is something I don’t think we realize. You see, in nearly all of life, you can only have TWO.
Never THREE.
Ever heard of a restaurant called The Palm? There are several in the United States and they have a reputation as one of the finest. The food is exceptional {good}, and its served in a timely manner {fast}, but since it’s prepared fresh to your exact preference from the finest ingredients, it’s expensive {not cheap}. When it comes to any restaurant, my wife and I agree—you get what you pay for.
We may not like it but we’ll automatically accept a price if the goods meet two of the qualifications, never even realizing we didn’t get all three.
And this is a very important aspect that is about to affect our lives deeply.
It’s regarding healthcare.
And this is the little secret that no one wants to discuss.
- We want all three.
- Our politicians are promising all three.
- But we can’t have all three.
The American healthcare system was built on the premise that healthcare should be the best possible {good} and should be instantly available {fast}. By the above definition, we know it has to be expensive {not cheap}.
To carry out the goal of less expensive healthcare, we must accept a reduction in quality or availability {bad/slow}.
If you want to keep it cheap, quality must decline. A cheaper system rewards doctors less pay. This discourages the best and brightest from choosing medicine as a career. The debt burden is just too costly. At this moment a new graduate doctor will not pay off medical school loans until age forty. From a practical standpoint, who will choose medicine as a career?
Another result is it discourages industry from developing innovations to improve healthcare.
Cuba has a health care system that is an example of cheap and available but the quality is substandard when compared to the United States. There are procedures and surgeries totally unavailable. I recently offered to go to Cuba to teach a procedure that is readily available in the United States. They were interested but don’t have the equipment nor has the procedure ever been done in the island nation. Innovations have been totally absent from this nation for decades.
An excellent example of the good-but-slow approach is Canada.
Overall, Canadians have good healthcare, but they often wait months for solutions that would occur quickly in the United States. The healthcare products retain quality and the price is cheaper. But the natural byproduct is shortages, creating great frustration. If this were not the case, Canadians near the border would not cross into the United States for surgical solutions to their problems that would otherwise take months to get.
For example, a woman with a rotator-cuff tear needed an MRI. Her appointment was one year away. Then surgery would be another year off. She came to the United States and had everything done in one month. At age 71 she continues her hobby as a long-distance cyclist. Incidentally, her husband died of colon cancer due to the Canadian system not covering colon screenings.
Another concern are further pay cuts to hospitals and physicians.
With universal healthcare a government has to cut expenses in several ways. A big way they do this is cutting reimbursement to physicians and hospitals. When government sets a fixed price for a hospital or doctor, expecting the same quality, the only option is less available healthcare.
This already occurs in our system with Medicare and Medicaid. Medicare patients without a primary care physician have problems establishing themselves in a new practice. Medicaid patients are not seen in certain practices or there are limitations on the amount seen.
In the end, this will drive many hospitals and doctor’s offices out of business.
Clearly, with the upcoming deeper pay cuts, some hospitals will have to close and surveys have demonstrated that up to 40% of doctors plan to stop seeing Medicare patients. Like many other physicians, I love the relationships I’ve built over the years with my patients. But the planned fee schedule cuts could make it impossible to deliver the same personalized care that so many of us want to provide.
To stay in business, changes will have to take place and this will impact either quality or availability. What a disappointment to both of us—the providers and the patients.
Controlling healthcare costs is a great idea.
Unfortunately, it will have a natural outcome of either decreasing quality or availability. Price fixing in any market results in reduced availability or quality. Either can be acceptable options as long as people are aware of what’s coming.
But are these acceptable?
To pretend we can have high quality healthcare that is readily available and affordable is disingenuous.
Unfortunately good, fast, and cheap cannot coexist.
At the very least, we deserve honesty from our political leaders.
Thoughtfully,
Steve
Photo credits: The Palm Restaurant website Morsani Center for Advanced Health Care website Canada Flag: Michael Yat Kit Chung Doctor's office tools of the trade: public domain Other photos by Alexandria Sage
