Earlier this year our dog was in a lot of pain for a few weeks and was taking a lot of painkillers because a car hit her and broke her pelvis (she is doing well and has recovered dragging me through our local park every day). Caring for her made me wish that going to the doctor or dentist was a lot more like going to the vet, in one very important way: health insurance isn’t involved, so we’re pretty clear about our options and, most importantly, how much those options will cost. When we go to the doctor or the dentist, the only price we pay is the co-pay, and when we talk about medical treatments, we don’t learn much about the menu of options and the price of each one. We had our dog repaired with stitches and medication, paid for it all in one go, and now have no extra bills, paperwork, or unpleasant surprises from insurance companies we should expect.
Not a damn. No hassle. No complicated paperwork. No uncertainty. Taking the dog to the vet was more like taking the car to the store than a doctor’s visit. We went in, they told us what our options would cost, and we chose. In contrast, I don’t have much incentive to pay attention to costs if my only out-of-pocket expense is a small copayment, and the insurance company takes care of the rest. What the insurance company paid for my visits to the optometrist and sleep clinic are important parts of my actual compensation, although they don’t care because they don’t show up on my checking account at any point. Would people feel like their real incomes were stagnating if they received their raises as salaries instead of as increasingly expensive health benefits?
But isn’t health care a human right? The United Nations says yes–but declaring something a human right doesn’t change the fact that we can’t provide it without resources we can’t use to produce something else. Of course, we can all think of ways that other people waste their money on frivolous nonsense. Still, we would do well to look in the mirror and ask whether we should spend $1,000 on flight, hotel, and meals to participate in a protest march in Washington, DC, because we believe the government should give something “free.” must provide. .” When we say something should be “free” it’s a shorthand way of saying “someone else has to pay for it” – and eliminating prices doesn’t eliminate costs. It just hides them.
Moreover, the amount of healthcare what people ‘need’ depends on the costs. Diabetics don’t have many substitutes for insulin, but in difficult cases bad laws apply and there are alternative treatments. For many other, minor ailments, many different ways to treat them don’t have to involve doctor visits or medications. For example, economist Bryan Caplan recently decided on a trivial reduction in the mortality risk of a tetanus booster wasn’t worth the pain and suffering of a needle stick and decided not to get one, which caused some unnecessary controversy on Twitter because there is a difference between thinking vaccines will hurt you and thinking a vaccine will be for someone else is -contagious disease that kills two Americans a year is not worth it. Earlier this week, one of my nieces got a splinter while visiting us. Did we call 911 and insist that they prepare an operating room for the extraction? No, we got out the tweezers. When someone else pays, it is easier to “need” more health care.
“This is the price we pay for healthcare equality and justice” doesn’t convince me. An ambulance that transports someone with abdominal pain (or a splinter) cannot transport someone else at that moment. Ambulances need resources: when we say ‘yes’ to another ambulance, we say ‘no’ to another fire truck. The right choice is not clear with prices that make the trade-offs explicit.
Taking your dog to the vet shows you how the market loves you – and your little dog too. Life would be easier if going to the doctor was more like taking the dog to the vet.
Art Carden is a Professor of Economics and Medical Properties Trust Fellow at Samford University.