Too much health

Health is increasingly becoming a politically unwinnable issue. People demand the best health services but refuse to pay extra for it. In surveys, they say they are willing to pay higher taxes for better health and education, but every politician knows that what people say in a casual survey is far different to how they actually behave.

Health is the most difficult non-security issue for modern governments, especially in the ageing West.

The largest-ever health financing survey by the American think tank, the RAND Corporation, put thousands of patients on different co-payment and compared their usage of health services with their health outcomes over a number of years. It showed that when patients have to pay a reasonable slice of the health care cost, they buy fewer services.

This is bad, isn’t it? People won’t show up even when they’re sick.

Wrong. They just think about it more carefully. Like other transactions, when a buyer thinks it’s important they will take the time to assess the information and make a more informed decision. The study found the actual effect on health outcomes was minimal.

Payment basically wiped out a large portion of the “worried well”.

A big reason for why there is a growing resentment in newly qualified doctors is that the nature of the job is so different to how they thought it would be. While no job is like its television representation, the biggest gap in expectation and reality is probably in the medical industry. Newcomers hoped for a prestigious, well-paid job where they happen to have a significant impact on human lives.

Instead they get a job where they are inundated with patients whose problems are often more related to sociology or economics than actual medicine. Furthermore, they are trapped in the public sector for years on end with relatively poor pay. They are the losers of global capital, trapped in an essential service caring complex.

While health should remain a social good and there should certainly be a safety net for poor and disabled people, it is important to question the modern role of a doctor. Do we really need to train people for a decade when so much of their daily experience is primarily that of a social worker.

It becomes less clear whether we need more doctors when their actual activities are put into question. Health is a classic case of an area where resources are allocated poorly because the market is not allowed to work effectively.

If doctors were more expensive we would go less and go when we needed to. The effect on health would be small. The savings in our national budget would be extraordinary.