THE GOALS OF A HEALTH CARE SYSTEM

By Dr. Lawrence Wilson

All information in this article is for educational purposes only. It is not for the diagnosis, treatment, prescription or cure of any disease or health condition.

Before discussing details about health care policy, a critical question to ask is, “What are the goals of the health care system?” The reason for asking the question is the goals will help determine the structure of the system.

One may say, the goals are obvious. They are to maintain and improve the health of the people at a reasonable cost, while respecting the rights and freedom of the people.

While this sounds good, in fact some in positions of leadership may have other goals that are not stated or even admitted. In some nations, however, they are admitted.

For example, in some of the socialist nations of Europe and in Communist Russia, important goals of the health care system are:

- To maintain and enhance political control of the people.

- To spy on a very intimate area of people’s lives.

- To keep the people dependent upon the government.

- Possibly to keep the people in a mediocre state of health so they are less able to rise up and rebel against government authority.

These may seem like cynical uses for a health care system, but they are rational and legitimate goals of a powerful central government. We should not assume that these same goals might not apply in America and other nations, as well. The truth is, they do apply.

CAPITALISM VERSUS SOCIALISM OR COMMUNISM

The goals of health care have a lot to do with the economic arrangement of a health care system. In a purely capitalist or free enterprise economy, the main goal of any business enterprise, including health care, is to satisfy the needs of the customers. If one does this, one succeeds and makes a profit. If one does not satisfy the needs of the customers, one goes out of business.

However, if the economic arrangement is a socialized one – characterized by government control and intervention – then the goals automatically change because the incentives are very different. No longer are people rewarded for satisfying the needs of their customers, clients or patients, in this case.

Instead, doctors, hospital administrators and others are rewarded when they satisfy their government-paid supervisors who run the system. The supervisors, in turn, want to keep and enhance their jobs. They assure this by seeking to bring more people under their authority and control. The only way to do this is to keep the customers dependent and ill so that more of them will need the services of the government health care agency.

Often, the government workers are also snoops who want to know as much about the people they supervise as possible.

THE CHANGING GOALS OF HEALTH CARE IN AMERICA

Over the past 100 years, America has moved from a capitalist or free market health care system that served the nation very well for about 120 years, toward much more government participation and control over health care. The percentage of care paid for by the government has increased from about 10% in 1900 to over 60% currently.

This has occurred in America in small steps including:

- Passage of the most state medical licensing laws starting around 1915.

- Establishment of the Veterans Bureau in 1921

- Constant increases in veterans programs during the early 20^th century.

- Passage of Medicare and Medicaid laws in 1966 and 1967.

- Growth of government-funded medical research such as the National Institutes of Health.

- HMO Act of 1974, which nullified older state laws against paying doctors to deny care, for example.

- Passage of HIPAA (Health Insurance Portability and Accountability Act) in 1996. This act destroyed doctor-patient privacy.

- The Affordable Care Act of 2010 (Obamacare). This greatly increased government control over health care in a number of ways.

With this change in the economic structure of health care has come the inevitable shift in the goals of the system, even if they are never stated or admitted. This is important to recognize or we will never get health care policy correct.

One cannot have a government-controlled health care system and, at the same time, have the real goal of the system to truly satisfy the needs of the health care clients or consumers.

The reason, once again, is simple. The incentives are incorrect. In the government-controlled model, the incentive is to satisfy the government rulers, and not to satisfy the customers or consumers of health care.

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