The Only Health Care Question

There's no limit to demand for health care.

There's a lot of talk about health insurance, the uninsured, single-payer, co-pays, and other topics related to health care, but everybody ignores the real question - how do we limit demand for health care?

If the government gave everybody free food, taxpayers would pay a lot of money, but there's a limit to how much anybody can eat.  Unfortunately, there is no limit at all to how much health care a person can want.

I have a friend who lives in a town which lets people on welfare go to the emergency room for free.  Last week, she had stomach pains, so she went to the  ER.  After a CAT scan and some tests, they concluded it was gas.  A couple days later, a trailer truck blows sand in her eye, so it's back to the ER for ointment and an eye patch.  When she goes back the next day, everything's fine.  The next day, she thinks she's having an asthma attack.  The ambulance takes her to the ER for lung scans, oxygen, and an inhaler.  The next day she goes to the ER for back pain.  As luck would have it, she sees the same doctor.  He's fed up by now so he gives her pain pills without doing any tests.

What did all this cost?  Scans are $3,000 to $5,000 and can be a lot more.  Blood work, eye washes, ambulance rides, it all adds up.

So far, human wisdom has found two and only two ways to limit demand for health care.  In England, Canada, and a lot of other places, they limit demand by fixing the annual budget for health care.  If people want more services than the budget can handle, they wait in line.  Enough people die in line to stay within the budget.  People with money come to the US and pay for their own health care rather than wait.

The other way to limit demand is by price - if you can't pay for the operation, you can't have it.

My friend doesn't pay anything for medical care; she goes to the ER like it's her second home.  If medical care is free, how do we limit demand?

That's the only real question about health care.  Everything else is a detail.

Will Offensicht is a staff writer for and an internationally published author by a different name.  Read other articles by Will Offensicht or other articles on Economics.
Reader Comments

I think you raise an interesting question, and it seems to me that the two solutions you mention... both resulting in people who truly need healthcare being unable to receive it, have failed us thus far.

What I have noticed to be a frustrating trend in healthcare is lack of coverage for preventative medicine. Diet specialists, physical therapy for chronic pain, etc. are not covered under my health plan that I pay hundreds a month for.

Could a focus on preventative medicine possibly be part of the solution? Perhaps it would eliminate some of the larger expenses incurred when those little problems become operable ailments.

As for your friend, she seems to me to be somewhat of an exception to the rule, perhaps a bit of a hypochondriac. I doubt that this behavior would be exhibited by the majority of a society in which health care is free.

August 28, 2007 2:31 PM

You would pay far less if competition ruled the medical industry end to end.  As for the woman in this article, she would rule, not the exception.  There was a great article in the Wall Street Journal today about this titled "Who's really sicko?".  It shows how countries with socialized medicine are looking for ways to re-introduce market medicine because of all the failures.  The lines are getting ridiculous.  In Britain, a dog can get a surgery in 2 weeks that would take a year for the owner.  Why?  There is no socialized medicine for animals.

August 28, 2007 5:15 PM

Max is COMPLETELY RIGHT about preventive medicine, however, there is a philosophical issue of individual responsibility.  All the preventive medicine in the world won't help someone who eats too much and gets Type II diabetes.  I don't say that all diabetes is caused by overeating, but bad diet certainly makes it worse.  Most states require that parents vaccinate kids before sending them to school.  Should states require that parents feed them healthful diets?  

Preventive medicine is largely an individual responsibility; it is hard to mandate it.  Is society obliged to pay medical expenses for someone who smokes and gets cancer?  

What if someone is hurt in a car accident but wasn't wearing a seat belt.  Given that they contributed to their injury, should society pay all the medical bills?

As for my friend being an exception, I know six welfare recipients pretty well.  ALL of them abuse the ER.  Ambulance rides, hip replacements, power wheel chairs, it all adds up.  Suppose that only 1 in 10 people abuse the medical system, which data suggests is WAY optimistic.  That is enough to lead to staggering costs.

August 28, 2007 9:18 PM

Yes the extremes can happen in any case you can think of. However, most people don't want to go to the doctor UNLESS THEY HAVE TO.

August 29, 2007 4:13 AM

No, Will's contention is correct.  England, famous for its National Health Service, has this problem to an enormous extent.    It's so bad, that they have to post big posters on busses and in the Tube, saying "An ambulance is NOT a taxi service."

August 29, 2007 8:41 AM

I think one thing that would help reduce abusers of the system (like your friend) from continuing their pattern of abuse is if their friends told them what they thought.  Perhaps they are not aware of the costs involved in treating them for injuries that are not really injuries.  Perhaps if these people lost friends as a direct result of  moral lapses such as this they would think about changing their ways.  This is just one of many signs that society accepts people of low moral character with open arms and open hospital doors.

August 30, 2007 8:46 AM

Simple enough.  The legislature is over-thinking health care like everything else.  Whenever there is a problem with government, remove financing instead of adding more.

September 5, 2007 3:26 PM

JC said that people don't go to the doctor unless they have to and John M. said that peer pressure ought to help people learn to avoid unnecessary visits to the medical system.

Unfortunately, they are both wrong.  I have a friend in his early 60's who has gone to the same General Practitioner for years.   He and the GP have become friends.  The GP has been in town long enough to have a reputation for taking care of old people, so he has a lot of older patients.

"Coming to me is part of their social life," he tells my friend.  "There's a bunch of them who try to get their appointment times together so they can chat in my waiting room.  It's becoming a regular meeting place.  How do I charge for that?  Can I bill Medicare for the 8th visit for sniffles in the same week?"

Is the doctor's office a sort of My Space for the elderly?  Who's going to pay for this?

This problem is especially severe with cancer survivors.  They're used to socializing at the doctor's office because they spent so much time there and there are now more than 8 million of them in the US.

The ONLY issue with the medical system is now do we limit demand, everything else is a detail.

September 11, 2007 10:40 AM

Good point. Need also to talk about "Health Care is a Right". That implies that the ER door must be open to all.

Look at  "Individual Medical Investment Account".

Would this help?

December 20, 2007 8:43 AM
All of you are overlooking the main issue with health care. It is not an economic issue! it is a social and moral issue that result in economic impacts. Do not understand why this is always left out. Not too long ago we (Americans) arguued that Karl Marx was wrong because he made everything an economic concern. Is that true? If so, I suggest that all of you begin discussing the moral issues involved in issurance companies not paying for medical care that could save a life? Or, ER's doing an emergency quadtruple by-pass operation on a patient who came in with heart burn and no insurance? Or, as is being done in Massachusetts, saying that health insurance is like auto insurance, everyone's responsibility and thus everyone will buy health insurance, end of discussion!
January 3, 2008 11:01 AM
Dahju, why should there be any difference between health insurance and auto insurance? Hospitals are businesses like any other. If their customers do not pay them, they cannot operate.
January 3, 2008 11:09 AM
Ifon, there you go again, arguing economics for a moral question.
January 3, 2008 11:14 AM
What exactly IS the moral question? That health insurance deals with quality of life? Everything deals with quality of life in some way. What IS the moral question here?
January 3, 2008 11:18 AM
The moral aspects of the health care situation are being most of all overlooked. It is a known fact that 2/3's of healthcare costs are incurred in the last few months of life in attempts to prolong a life regardless of whether there is quality of life. None of us want to lose a loved one, even if the life is only kept for a few days more. Yet, in some Eskimo socieities, once an elderly person can no longer carry there share of the load, they are left to die. It is the duty of the elderly to not become a burden to their family because in the harsh environment of the Artic extra burdens cost the lives of others. That is a moral decision. A Democratic Colorado Governor was nearly run out of town on a rail for suggesting that the elderly in our society likewise should consider such action by refusing actions that only prolong life not the quality of life. If the answer to the moral question is that all societally available efforts are to be expended to keep life, the question is not how do we deny service. The question is who must sacrifice to ensure all efforts are available to everyone regardless of cost. The Massachusetts answer is that everyone bears responsibility for the care of everyone in society. As a member of the society you have to share in the cost becase everyone benefits, no options. Just like auto insurance for all drivers.
January 3, 2008 11:33 AM
You are confusing two issues. The only moral question in health care is when to bill - before or after care has been given. If society chooses to bill after, then society is saying that it is more important to care for life then to collect payment in the event that life itself is on the verge of ending. That is NOT to say that the bill should be demoted or ignored all together. If someone can't pay the bill (particularly in light of such a magnanimous gift their fellow citizens have given them) they should be taxed for it until they HAVE paid it or they should be made to use cheaper options/hospitals. Massachusetts has tried to get around this problem by simply insisting that everyone carry enough insurance. As long as it is managed privately, I agree with it.

Social Security should be handled the same way. The program itself should be trashed and the government should mandate that all registered corporations MUST offer retirements plans for all employees. Every employed citizen would then be required to make a certain contribution to that plan with each paycheck. The government would not be involved in any of it except for mandating that it must be so.

Just because society has made the decision to care first and bill second, doesn't mean that health care at large should not be driven economically. It's just a matter of defering paperwork.

As the author demonstrated, we have to figure out how to limit demand. But we also have to figure out how to make the supply more efficient.
January 3, 2008 11:53 AM
Dahju said: "As a member of the society you have to share in the cost becase everyone benefits, no options. Just like auto insurance for all drivers."

Since when??? Everyone in society does not share in the cost of auto insurance. You are free to buy it from any company you want. In any quantity or amount you want. For any number of vehicles. Most states make you have liability insurance but they do not sell or oversee it. And it's completely different depending the private company you buy it from. And you can choose to have comprehensive and collision or not. No one forces you to have it. No one forces you to use it. And no one else benefits from you having it or not.
January 3, 2008 12:01 PM
Dahju is somewhat confused. The issue isn't one of morals, it's one of individual freedom.

Morals are relevant in public policy when dealing with interpersonal relations. For instance, murder is immoral because it it harms somebody else (the victim). Moral crimes which have no obvious victim, such as prostitution, are far more squidgy, and are usually justified by saying that there are in fact victims (e.g. women who are forced into prostitution against their will.)

In the case of health care, there is no other victim. There is only the patient, who does or does not receive care. But if a large bill is run up that doesn't get paid, then there becomes a victim - the hospital, the doctor, and by extension everyone, who has to absorb the cost. That's what's immoral.

Yes, if a person does not receive necessary treatment, they may die. And even if they do get treated, they may die anyway.

It's equally true that driving small, cheap cars is more dangerous than driving big heavy ones. Does this mean the government has an obligation to provide a big solid car to everyone who can't afford one?

It's also true that poverty reduces health. By making health care free to all, it will obviously have to be paid for by much much higher taxes. This won't hurt Bill Gates much, but will make the difference between not-quite-poverty and actual poverty for a whole lotta people, thus reducing their health as well as quality of life. Is this moral?

No, the real issue is, who gets to decide. An individual can decide not to buy life insurance, thus trading the more stuff he can buy now against the chance that he'll croak and leave his family without. Should that be illegal? There are all kinds of decisions, some smart, some stupid, and some which could be either depending on the circumstances. What sort of arrogance drives Hillary, Obama et al to think that THEY can decide what is better for YOUR life than you can?
January 3, 2008 12:07 PM
How did SS get into this? Completely different question that involves very differnt issues, like SS is an insuranc program, not an investment plan.

As to finding the least cost provider for healthcare services: When you believe you are having a heart attack, you are not going to be calling around or searching the web for the cheapest responder; you are going to be seeking a provider that responds to your problem, cost be damned. You cannot seriously pose that someone has to do a cost analysis during such a event, whether or not they have insurance.

I do agree that more emphasis needs to be placed on personal responsibility like taking appropriate preventative action: proper diet, exercise, etc. This needs to be made more visible and cost to the individual rewarded to encourage proper actions. Preventative actions impact all health care costs and demands.

And, yes healthcare must be more efficiently delivered, such as using physcians assistants instead of doctors. When I was in the military we had outstanding healthcare for me and my family, and the care was delivered in clinics with liberal use of assistants. (That is much use of not politically liberal.)

Have to break off for a while. Must pay for this fun by doing some work.
January 3, 2008 12:28 PM
Ahhh.......... While I was away I see there are some very interesting comments added to the fray. Will address each in separate responses. Please be patient; will get there.

kramerCakes, do not want to wander too far from the core discussion about healthcare and morals; however, your statements about auto insurance, one of our references because of the Massachusetts model, do need some factual basics added to the discussion to clarify the model: True, auto insurance does very much vary from state to state as to what is required. New England states generally have more requirements than average and thus the apporpriateness for application to the healthcare discussion. In Maine, where I live, the state REQUIRES showing a valid insurance certificate issued by your insurance company to register your vehicle, no insurance, no registration. Every driver must have min liability coverage of $25,000 property and $50,000 medical per person and also Uninsured vehicle (because some states still do not require insurance). The society in this case is ALL drivers of any vehicle registered in Maine. The protection is for the other driver. The state recommends collision be a part of all insurance policies. If you are stopped for any reason by the police, one of the standard requests is to show your insurance certificate for the vehicle you are driving which has to have you listed as covered and which you must carry in the vehicle. To not have coverage is considered a violation and you can be cited for not having it with a $100 fine and showing a current insurance certificate to the court to be reinstated to drive the vehicle. Yes, you can have any insurance company you desire or if you have such a poor driving record no one will sell you insurance, you must buy through the pool of high risk drivers from the insurance companies doing business in the state. And,yes, you can buy more than the min requirement. Most today carry $1 million medical and $250,000 property for liability and the same for collision. Deductable varies by choice and of course can have very different policy costs depending most on deductable and age/cost of vehicle. The Massachusetts Health insurance requirement follows the same model. Yes, it does have individual choices but only after the minimums are fulfilled; and it is enforced. One impact is most clunkers are off the road because they are uninsurable. We do not have no-fault. Someone is always found at fault and all claims are investigated by the insurance claims adjusters; usually by getting copies of accident reports and photos emailed from police and certified garages. It is not unusual today to have someone prosecuted for bad news road behavior such as driving with a suspended license, which will land you in jail for 1-10 years. I have been involved twice in accidents since the insurance requirement has been in force. In my cases, the claims were filed within 8 hours (a requirement, except for final for medical); the checks were sent to the garage for repairs to be made by funds e transfer and the repairs made within a few days. No hassles and no challenges by insurance companies for freviolus reasons, banned by the state. If only the health insurance coverage could be so simple.
January 3, 2008 4:51 PM
Patience, the issue of health care is first and foremost a moral question. Is our society going to provide health and emergency coverage for all citizens or is it not. I remember well my parents discussing a time not so long ago about family members who died or were crippled for life because the family lacked the insurance or financial resources to pay for the medical services needed. Such a situation happened to the family of the founder of Starbucks when he was a child. It so impacted him that he swore if he ever was in a position to effect such situations he would do all in his power to ensure the people have the coverage they need. So, today Starbucks provides medical benefits to everyone of its employees, even part timers. The moral issue I am raising is whether or not the individual should be provided the care no matter his financial status. If the answer is yes; then the money must be obtained from some where to pay for the care. In many cases the individual recieving the care does not have a pray of getting the money ever to even pay a fraction of the cost (the Starbucks example). So who must make the sacrifice. In Massachusetts the answer is in part, everyone. It is not a matter of paying before or billing after, it is a decision that society will provide the care and everyone must bear some responsibility as members of the society, no options. To do otherwise is to always make someone else pay, not me. I have never understood some of my conservative friends who claim that there is waste in government, especially the medical programs who then have that quadtruple by-pass operation mentioned earlier with no insurance when they can afford to buy insurance and pay the min to the hospital and ER costs. If you do not deny the care, then there must be some way of imposing individual responsibility whether by taxes or forced consumer buying.
January 3, 2008 5:19 PM
In all of that, you still completely failed to demonstrate how buying auto insurance is a burden that everyone shares. Don't bother; you can't because that isn't what happens. Each person is responsible for themself and ONLY themself. And accordingly, that person bears the consequence.

The same should be true in health. And until it is, we will continue to have the problems we do.
January 3, 2008 5:24 PM
Dahju is spinning the issue such that health care is defined by the minority of cases where deadbeat don't plan ahead and refuse to spend money on health insurance (because they know the rest of us will pay the tab). The left has played this game (effectively) for decades.

It is always assumed that the person given care will pay for it. We do not give treat first and bill later because we have "answered some moral question that health care is a basic right". That is tomfoolery. We treat first because we don't want people to die in the waiting room while they fumble with their checkbook.

No one who receives health care, receives it under the pretense that "someone else in society" will pay for it if they can't. They are expected to pay like everyone else.

There is no other "moral question". Treat first, bill later - is about helping someone who has a heart attack get on the operating table before he writes a check. There is nothing more.

No one in society has decided that health care is to be provided to all. That is a silly dream by those who would have it be so. And economically, it cannot be accomplished. You either die waiting in line for 6 months (if you socialize it) or you sell it to the highest bidder. That's the way every scarcity in the world works. Health care is - like every other produced thing - scarce. There is nothing magic about it. Doctors don't grow on trees.
January 3, 2008 5:40 PM
Ifon said, "No one who receives health care, receives it under the pretense that "someone else in society" will pay for it if they can't. They are expected to pay like everyone else."

I WISH very much that ifon was correct, but that idea is simply wrong. I know a number of welfare recipients who go to the emergency room like it was a second home. Some of them have free electric wheelchairs that cost about $4,000, they use them as if they were automobiles and gripe when they get stuck in the snow. They not only want free health care, they gripe when they have to wait in the emergency room. They have NO expectation WHATEVER of paying for ANYTHING. They don't expect to pay for food, or housing. They gripe about waiting 2 weeks between welfare checks to buy the food they want. They agitate for bigger apartments.

The liberals created an entitlement mentality so the people who got benefits would vote for more programs. This has worked brilliantly. One reason liberals want to give citizenship to illegals is so the illegals will vote for more welfare benefits.

The main health care problem is that too many people have NO expectation of paying for it and they want nothing but the best.
January 3, 2008 6:05 PM
Allow me to clarify. I meant - under the GIVER'S pretense, not the receiver's.

Of course, the receivers expect someone else to pay for it. That's why they go so often and take advantage of so much. They know the game.

But the health care GIVERS expect the person to pay for it each and every time. They might know, judging from the last 10 times the person came in, that in reality the person will not, but they still expect the person receiving treatment to pay for that treatment because that's the way our system is.

Dahju is trying to suggest that society has somehow already decided that we have made the greater decision to give "to each according to his need from each according to ability" but we have not. And we *should* not.
January 3, 2008 6:13 PM
This anecdote does not pass the sniff test, starting with you (the author) having a friend on welfare.
August 21, 2008 3:24 AM
Katy, uh... what?
August 21, 2008 8:01 AM
Katie raised an excellent point; it's addressed at
September 1, 2008 11:56 AM
Austin Emergency Roomss got 2,678 visits from 9 people over 6 years

Task force seeking ways to divert non-emergencies away from emergency rooms.

Wednesday, April 01, 2009

In the past six years, eight people from Austin and one from Luling racked up 2,678 emergency room visits in Central Texas, costing hospitals, taxpayers and others $3 million, according to a report from a nonprofit made up of hospitals and other providers that care for the uninsured and low-income Central Texans.
April 1, 2009 3:09 PM

You limit her demand for going to the emergency room by giving her access to a non-emergency doctor.

March 25, 2017 2:44 PM

+Barbara Saunders

That sounds good, but it doesn't work either. I have a doctor friend whose practice includes a number of elderly people. They come to his office about once every week or two to get together, talk, and see him about whatever ailments they think they have. These unnecessary visits don't cost as much as ER visits, but they do add up.

March 25, 2017 8:37 PM

"I have a friend who lives in a town which lets people on welfare go to the emergency room for free."

I don't understand the point of the article. It is always true that anyone can go to the emergency room whether or not the have insurance and whether or not they can pay. Being on "welfare" is a non sequitur. This is where everyone who is uninsured in America goes for healthcare.

So should we not allow people to use emergency services if they do not have money up front or insurance? Is that the proposal?

I can presume that "dying in line" is nonsense since I have known many, many Canadians in my life, and have used their healthcare system myself, neither waiting nor dying in line. But to assume for argument it is true, what is the advantage of allowing people to die for lack of treatment vs. waiting for it?

April 13, 2017 10:29 PM

@Terry McDanel

I understand your point, but the Canadian system works only because people with money can go to the US to avoid waiting. I know many who've done precisely that.

NO society has figured out how to provide all the health care everyone wants for no cost to the patient. The only way to stay within budget is to make people wait, as Canada does. Since our stated policy is to treat everyone no matter of ability to pay, there is no reason for practitioners to cut costs. They won't get any more patients, so why reduce their incomes?

We have to address demand somehow.

April 14, 2017 1:17 PM
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