Friday, 14 September 2012

"Social Justice" In Healthcare

"...NHI expenditure on households with the lowest 20 percent of income grew by only 4 percent between 2000 and 2009, but expenditure on households with the highest 20 percent of income grew by 40 percent in the same period,” Consumers’ Foundation board member Hsieh Tien-jen (謝天仁) said.
“Rich people are using more medical resources than poor people, but paying the same premium rate,” he said."
How is this happening? 

First, the obvious economic possibility; relative to their income level and the rate at which they are charged under the NHI system, the costs of medical treatment to the people in the top 20% income bracket must have either remained low, or decreased relative to their income over time. If this is what has happened, then it must surely be due to rises in income for these people whilst medical costs have remained static, rather than their income remaining static and medical costs falling. 

A second possibility is that the people in the top 20% income bracket are using up comparatively more expensive resources (e.g. chemotherapy?) than the people in the lowest 20% income bracket. If that is true, is it because the rich are comparatively less healthy than the poor (e.g. with fewer fruit and vegetables in their diet, less exercise and greater consumption of alcohol)?

And a third possibility could lie with a disparity in disposable time; are those in the top income bracket more easily able to take time off work to go to the clinic or the hospital (or to stay home "sick") than those in the bottom income bracket?

Or, of course, some combination of all three...?

In any case, it should be noted that although the rich may be paying the same NHI rate as the poor, the absolute value of their payments will of course be many times higher than that paid by the poor due to the disparity in income.

So the rich will already be paying more than the poor for their consumption of medical resources as well as consuming more of these resources - but of course it is not enough that the rich merely pay more is it? The implication laid out by Mr Hsieh is that either the rate should remain unchanged, or it should be adjusted downwards rather than upwards, and - in addition - the NHI should monitor and regulate spending more tightly to avoid inequalities of outcome wherein rich people can afford to spend more on their healthcare than the poor.

Yet haven't richer people always been able to spend more on their healthcare (or - logically - anything else) than poor people? Isn't that what being rich ultimately means - that you have more cash to splash? What was Mr Hsieh expecting? That the government (with help from their freinds in the medical industries of course) could construct a socialized healthcare system and expect a broadly egalitarian or platykurtic distribution of consumption?

To avoid inequalities in the distribution of resources like this, then either the State must eliminate (or "alleviate", in the Left's Orwellian phrase) income disparities or it must impose a command-and-control regime over healthcare expenditure.

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