The idea that abandoning our national affordable care system and turning over health systems policy to the states will resolve the fiscal crisis in our nation is absurd. Simple demographics make it a bad idea.
With the exception of age-related maladies such as senile dementia and a few others, illness strikes in ways that are best understood as random. Almost no state has a population whose age distribution, ethnic mix, income, education, etc., closely mirror the national equivalents. Thus it is entirely predictable that the distribution of illness in some states will overload specific forms of care while in states with younger, healthier populations, medical services will abound and may be surplus or squandered.
Consider two hypothetical states A and B. A is in the rust belt, and its population is relatively old due to the decline of traditional industry and economy and consequent out-migration of young people, who take their earning power and their children (AKA future earners) with them. B is experiencing rapid in-migration its modern economy is creating new wealth and infrastructure that will continue to expand for decades.
A will likely be unable to provide adequate services to its population based on some national average block grants; it will be unable to pay for home care or even common services. It will be forced to raise the share of costs that must be borne by the individual, leading to increasing poverty. Parents will be obliged to pause before seeking care for their children’s injuries or minor illnesses, leading to long-term health consequences that will further unbalance the system. Certain high-cost medical procedures and specialties will become unavailable. Although it is purported that “choice and options” will increase, the real choice will be between medical care and other essentials, with the only option being relocation. Yet because the majority of A’s citizens’ wealth is tied up in their homes and their income is tied to declining local industry for which they were trained long ago, relocation is not a viable option.
B’s citizens, in contrast, will never have had it so good, at least for a while. Their economic and demographic advantages will mean that no one will have to pause before seeking care. Cosmetic surgery and other non-essential specialties will be growth industries; noses and breasts will be reshaped and augmented in every village and town. Medical specialties and procedures now unavailable in A will be a net revenue producer for B, leading to further outflow of A’s wealth and thence to further decline it A’s ability to finance health care. Medical training will continue to migrate to large, rich states, while small, poor states struggle to buy aspirin and adhesive bandages.
These effects will also operate at the local level. Poor counties will get poorer; rich ones will get richer; this will be most apparent in large states like California, Texas and Florida at one end and in Michigan, Mississippi and the Great Plains at the other.
Today we’ve learned that the “(R)eject and (R)egress” effort in Congress has failed again. Good news, but have no doubt they’ll be baa-ack one day soon. Beware!
Latest Bad Health Care Idea Dies in Congress © 26 Sep 2017