MARCUS: A feast of perceptions about health care

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Morton Marcus

“Does anyone understand the health care debate?” says Kenny Koloa as we sit down to lunch at the Indiana Buffet. 

“What?” I ask indifferently, my attention drawn to the giant breaded tenderloin on my plate covering the dish of meatloaf, German potato salad, and green beans with bacon.

“Health insurance,” Kenny replies, distracted by his plate of fried chicken, fried okra, mashed potatoes and gravy.

“Are you talking health insurance or health care?” I ask.

“What’s the difference?” he asks. “If you don’t have the insurance, you can’t get the care.”

“Not true,” I say. “Lots of people are without health insurance, but that doesn’t necessarily mean they go without health care. Others have insurance that doesn’t cover their needs. Either they don’t get the care or they go broke in the process.

“The issue is, Do we want everyone to have access to basic health care without regard to income? If that’s the case, we need to set up a system similar to Medicare.”

“What happens to the patients’ right to choose the doctors they want?” Kenny asks while licking chicken from his fingers.

“Under Medicare, the patient chooses the doctor he or she wants,” I reply, “unlike many insurance plans where you have to choose from a list of selected practitioners. Choice increases.”

“Won’t doctors and hospitals be shortchanged just as they are under Medicare?” he asks.

“Have you seen the hospitals built in the past 10 years?” I ask. “They have become monuments to the egos of administrators and board members. They offer amenities that have little to do with health care.”

“As for doctors, some say they are paid generously because of their accumulated debt while in school, long years of training, and deferred income. We could underwrite the education of doctors and other medical professionals so they don’t accumulate debt. What if we increased the numbers of qualified medical professionals? Might we liberalize the rules as to what a doctor must do and what can be done by other professionals? Does any union have a stranglehold on its industry as do doctors on health care?”

“But if health care is less costly and more accessible, more people will utilize the system and we’ll be overwhelmed by patients,” Kenny says.

“We might have more healthy people. And a universal program doesn’t mean people are exempt from charges for health care,” I say. “We could require payments proportionate to income up to some maximum for catastrophic events.”

“Shouldn’t we require people to behave in a way that reduces health care needs?” Kenny asks. “What about individual responsibility?”

“What about it?” I say. “Look at how we’ve cut back smoking. Regulation and taxes, not responsibility. We improved the safety of autos by requiring safety glass, air bags and seat belts. Labeling on our foods gives consumers more information about what they are eating. We outlawed lead in gasoline and paint.

“Now we need to move on to new regulations of products and restrictions on individual behavior.”

“That’s intolerable,” Kenny says. 

“There’s no way around it,” I say. “We’ve made war on trans fats. Soon, we’ll outlaw fried food in public places. As long as we have one another tied up in a common system, we’ll insist that others behave to minimize our costs. The drive against cigarettes and for motorcycle helmets was not concern for the afflicted but for us as the financially affected.

“It’s a necessary tradeoff when our finances are intermingled. If we had much less income inequality and financial protection from catastrophic medical expenses, this whole discussion would fade away. Everyone could afford basic health insurance.”

“I’m going for the coconut cream pie,” Kenny says.

“I’ll choose either the banana cream or the bread pudding,” I say.•


Marcus taught economics for more than 30 years at Indiana University and is the former director of IU’s Business Research Center. His column appears weekly. He can be reached at mmarcus@ibj.com.


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