The “Tanstaafl” Paradox and Healthcare Reform
Guest Editorial
Callie G. Moore, BA, RAC
4/9/2019
As our country begins the ramp-up to the 2020 elections a good deal of rhetoric and press has been aimed at what has generally been described as “healthcare reform”. Specifically, the mantra of “affordable” healthcare for all, without defining what affordable actually means. In the most general sense, the push from one side of the political aisle is toward a single-payer government run healthcare system, with the requisite abolishment of private insurance, while on the other side of the aisle reforms mentioned most often include letting free market forces work to drive down costs while increasing accessibility and higher quality. It’s basically an argument between “free” versus “free markets”.
In an article written by the Vice President Henry Wallace published in the Atlantic Monthly in 1942, Vice President Wallace posited a post-WWII worldwide governmental model that would provide “minimum standards of food, clothing, and shelter” for all people throughout the world. A noble sentiment to be sure, but as Paul Mallon, a Washington journalist, pointed out in a critical Op-Ed piece “Mr. Wallace neglects the fact that such a thing as a ‘free’ lunch never existed. Until man acquires the power of creation, someone will always have to pay for a free lunch.” The turn of the phrase “free lunch” caught on with the public and became “there ain’t no such thing as a free lunch”, or Tanstaafl.
The intricate and dynamic web of the healthcare system in the United States is comprised of various sub-systems such as hospital networks, medical device manufacturers, pharmaceutical companies, insurance providers, regulatory agencies, and countless others, none of whom are currently working, or producing, or delivering care for free. Getting rid of the insurance companies, for example, would simply take their resources and push them somewhere else, perhaps to an entity using those resources in a less efficient and more costly manner. Before we simply make a switch from one healthcare delivery model to another, we need to know exactly how flicking down one domino may cause an unintended cascade of undesirable outcomes in other areas of the healthcare system. For example, if we go to a single government payer system and drive insurance companies out of business, what will be the cost to the economy? Specifically, implementation of a single government payer system will be getting rid of private sector employment and potentially bloating the government employee population: i.e., there won’t be a decrease in the need for people to handle the logistics involved in patient care, just a shift in who is responsible for managing it. Which is more effective a private sector job, or a government job (ask a patient of the Veterans Administration)? What is the cost to the taxpayer to employ the additional government personnel? What other feeder-industries will be hit, and at what cost, if private insurers go out of business? These questions must be considered by all stakeholders involved in this issue (especially voters) and answered in a thoughtful and realistic manner – not simply based on “feelings”.
There must be honest discussions relative to the total cost of healthcare reform in this country, regardless of the direction it ultimately takes, and whichever political party is at the helm. As the paying public, we need and deserve to know what these costs are and who will be bearing the brunt of them, and especially what we will receive in exchange. We need to be an informed citizenry that has a place at the negotiating table in deciding how to achieve an optimal balance between cost, quality, and availability of healthcare services, understanding that whatever and however services are provided, they must be paid for by someone. We must beware of politicians offering a free lunch: it may end up costing us more than we ever intended to pay.
Callie G. Moore, BA, RAC
About the Author: Callie G. Moore:
Ms. Callie Moore is the Director of Quality and Regulatory Affairs for the Longmont-based company Acertara Acoustic Laboratories and is a member of the Medical Imaging and Technology Alliance’s (MITA) Technical and Regulatory Committee. MITA is the medical division of the National Electrical Manufacturers Association (NEMA).
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