Cutting Medical Costs

Cutting Medical Costs

Another PajamasMedia reject.

President Obama is hot to extend health coverage to the 46 million uninsured Americans. (I’ll be polite, and not ask how many of those uninsured “Americans” are actually illegal aliens.) One of the strategies that White House National Economic Council Director Larry Summers was talking about in April was to reduce unnecessary surgical procedures. As economist John Lott pointed out, rationing medical care for the more than 250 million of us that do have insurance is the only realistic way to get everyone covered, without a substantial increase in government spending.

I cringe at the prospect of rationing, partly because I rather like having high quality medical care—I have no desire to live (and die) like a Canadian or Briton—but also because I’m concerned that rationing isn’t going to be across the board cuts. Some animals on this farm, I suspect, are going to be more equal than others. (I rather doubt that elective abortions, for example, are going to be rationed by the Obama Administration.)

I do have a suggestion, however, for one form of medical rationing that is less objectionable than others: prohibit medical procedures that are not medically necessary. For starters, prohibit all non-reconstructive, cosmetic surgery. Now, most health insurers don’t cover purely cosmetic surgery, I agree. (But not all. I recall one of the San Francisco Bay Area school districts went bankrupt some years ago at least in small part because the union contract covered a variety of cosmetic surgical procedures.)

But think about this: every doctor, nurse, operating room, and piece of equipment that is currently being used to do breast implants, tummy tucks, nose jobs, and a dozen other vanity procedures, would be freed up for medically necessary work. Competition would drive down wages. Plastic surgeons, after all, are medical doctors—and some doctors who advertise themselves as plastic surgeons aren’t really so specialized in their training that they couldn’t switch specialty.

How much of a difference is this going to make? In 2007, there were more than 1.8 million cosmetic plastic surgery procedures, along with “over ten million minimally invasive or non-invasive procedures” (such as Botox injections). Of those 1.8 million procedures, 347,000 were breast augmentations—about as unnecessary as a cosmetic procedure can be. (Even more absurdly, some of these are minors.) Do you suppose that with some spare on their hands, some of those doctors might be able to do something a bit more useful?

There’s another set of surgical procedures that are not only medically unnecessary, but are also hideously expensive: sex change. And some government health insurance plans actually cover it for employees: San Francisco (of course); Berkeley (of course); and a few other governments that have confused progressivism with extravagance (and confused confusion with needing a sex change). UC Berkeley’s Student Health Insurance Plan covers it (up to $75,000 per lifetime). And of course, the ACLU has sued Wisconsin and Idaho (at least) to require prisons to provide sex changes for prisoners who were born in the wrong bodies! But something tells me that the Obama Administration isn’t going to open that can of worms—it is so much safer to ration medical care for those who really need it. (If you think, “maybe they do need it,” read this 2004 article from the British Labour Party paper The Guardian, which recounts some of the experiences of those who have been changed once—then decided to go back—because sex change didn’t solve their unhappiness.)

I’m sure by this point some of you are getting huffy about how judgmental of a tone I have taken about cosmetic surgery and sex changes. I have no interest in the government making these decisions for others. But then I expect at least the same level of respect for my right to receive medically necessary care without governmental interference. I’m pretty sure, however, that these expensive and unnecessary procedures will be untouched—while millions of other Americans are waiting for colonoscopies, MRIs, and other truly necessary medical care.