Hollywood on health care

National Review, Sept 28, 1998 by William F. Buckley, Jr.

The movie As Good As It Gets has a sequence as follows. The lonely, impoverished woman has an asthmatic kid. A ray of sun is working its way into the crabbed heart of the rich Bad Guy. And lo! A doctor --a real live doctor -- appears at the mother's apartment one afternoon and says that he wants to examine the boy. Has he had an X test? a Y test? -- never mind; the doctor will see to it that the boy gets those tests. The doctor proceeds to probe a little, and ends the conversation with the tired mother by saying: ''I can tell you this. Your kid will sleep a lot better from now on.''

Lesson? You need to be rich enough to hire a private doctor before you can have any hope of getting the right kind of treatment for an asthmatic child.

Now one begins an analysis of the current health scene by acknowledging facts that cannot be made to go away, and should not. They are that rich people can afford extraordinary care. They can afford to do a lot of oddball and sometimes effective things, like going to Germany to take the baths, or sneaking in past the FDA an alleged miracle drug from Tibet. But in this movie, Hollywood is giving an impression in categorical terms, namely that unless you are wealthy, you can't get the indicated help for an asthmatic young patient. It isn't as if the mother had said, Junior needs a heart transplant of a kind that can only be performed by Doctor Bousialandris in Belarus -- in such a situation only a very deep pocket helps. No, the movie suggested we were looking at a conventional asthmatic condition.

It is the season to rail against the HMOs. Again, begin where it makes sense to begin: Some HMOs are demonstrably run without any regard for the purpose they were established to serve. But again, analysis requires that one ask, Why do people organize HMOs? Not necessarily because they are altruistically concerned with health care. They are, from the president to the hospital janitor, engaged in making a living and, if possible, a profit. If an HMO fails to make a profit, investors pull out.

Well, is there a way to cope with the dictates of market forces in a health system? Yes, you can nationalize medicine. What then happens is that there are no shareholders to distribute profits to; but with the disappearance of the shareholders, other claimants move in. Mostly, these are 1) suppliers; and 2) quality-entrepreneurs. In Great Britain if you want a hip operation you get it free. But you will have to wait two years before your name comes up. As regards high-quality medicine, rich people in England (or in most of Europe) travel to Houston or Boston or Cleveland for intricate heart work.

The search in America is for the squared circle. We turned down nationalized medicine because we knew its consequences. But we wanted free ''health care.'' Health care is defined as: Someone else (theoretically) pays for it. All you need to do is report to the doctor, or the hospital, and care is taken of you.

In the U.S., more than 13 per cent of our gross domestic product goes to health care. In Great Britain it is closer to 7 per cent. This means two things: 1) We have more health care; and 2) We have more money spent on health, irrespective of whether better health is achieved. If you pay $85 for a blood test that you could get for $20 by shopping around, you are not getting better health, though you are spending more money on health.

Enter the HMOs, whose design is to keep costs lower than they were projected to be back when every year health expenses rose by about 11 per cent. Granted -- once again, an elementary analytical point -- that this doctor or that nurse is more attentive than that one, or the other. What does not alter is that an attempt to lower the cost of individual subscriptions to HMOs has got to result in economies of some kind. This may mean the kid has to wait in line to see the doctor. It should not mean that he needs to find a J. P. Morgan in order to get treatment for asthma.

As almost always, the market comes up, not with solutions (what is the ''solution'' for having been born asthmatic?), but with approaches. The fundamental goal is restraint by the consumer. The Forbes Corporation approached this years ago. If you spend less than $1,200 per year on health, you get a bonus of the difference between what you did spend, and $1,200. Forbes employees (on the whole) spend less; and earn more. Nobody has noticed any difference in their level of health. o (Universal Press Syndicate)