democracy is a work in progress

Frequently Asked Questions

In The Wealth of Nations, published in 1776, Adam Smith wrote that a nation cannot truly flourish if a sizable number of its people are “poor and miserable.” In discussing the virtues of the increasing division of labor and the inequities it produced, he argued, “It is but equity, besides, that they who feed, clothe, and lodge the whole body of the people, should have such a share of the produce of their own labour as to be themselves tolerably well fed, clothed, and lodged.”

Since it is the division of labor that has givenb those trained in medicine the opportunity to advance our knowledge and technology for treating illnesses and extending life, would Smith’s vision include access to healthcare as a matter of equity for all?

The United Nations Universal Declaration of Human Rights, which the US helped draft, seems to think so. It states, “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care ….”

Not everyone agrees. One physician, Philip Barlow, has argued that it is unproductive to consider healthcare a right. After all, healthcare is difficult to define. While we might agree that it should include life-saving heart surgery and organ transplantation, might there be less agreement around cosmetic surgery or erectile dysfunction? Barlow raises similar questions in an editorial in the British Medical Journal.

When the ACA passed, some feared the medical infrastructure would not be able to absorb the influx of new patients.

Although the ACA greatly increased the number of people with insurance, especially through Medicaid, “findings on expansion’s effect on provider capacity are mixed, with studies showing increases, decreases, or no effects on measures like appointment availability or wait times”, according to a report by Kaiser Health News.

Whether continued expansion could be a problem in the future is an open question. There are already waiting times to see specialists in many parts of the country and for many conditions. Many workforce studies predict shortages of physicians in both primary care and specialties in coming years.

Defensive medicine is the term for practicing medicine with an eye toward avoiding a malpractice lawsuit. Physicians may go beyond what is required to diagnose and treat the patient to ensure they are not missing any possible condition.

American healthcare providers run many more diagnostic tests than in similar Western countries, for example. It is not known how much of this testing is due to defensive medicine, payment incentives, patient demands, or other factors, however.

One study found that physicians practicing in a system in which they do not need to worry about liability lowered hospital inpatient spending by 5%.

A 2016 legislative analysis by the Congressional Budget Office of a proposed federal law to limit malpractice lawsuits estimated it would reduce overall healthcare spending by one half of one percent (0.5%).

Overall, there is little evidence that proposed reforms to counter the costs of defensive medicine are likely to have much effect on overall costs.

There have been many proposals to shape insurance policies in ways that encourage lower spending by patients. One such proposal encourages implementing high-deductible insurance policies to deter patients from seeking excessive care. If a patient has to pay out-of-pocket to see a doctor, it assumes they may be more likely to rest at home with the common cold instead of seeking treatment.

Of course, a counter-argument is that high-deductible plans discourage preventive care, i.e. cheaper intervention before a problem grows.

Related Problems: National Debt, Income & Wealth Inequality

Contributors: Eric Seaborg, Ciara McLarenGeorge Linzer

Published: May 27, 2021

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