Health Care Slowdown

Isn’t it ironic that one of the largest economic sectors contributing to the Covid-19 recession is health care? Almost half of the massive first quarter US GDP drop comes from losses in health care spending. Just when the “best health care system in the world” is needed to kick into high gear, to be on its toes, agile, responsive, it slows to half speed. Are you surprised?

Your response to this news might be foretold in your response to the above phrase in quotes:” the best health care system…”. Nearly 70% of Republicans agree with that statement, while only 30% of Democrats do. The partisan divide in this country pivots on just what we expect of health care. We need some alignment of expectations.

Many analysts considered healthcare a “protected sector” in a recession, since they saw demand as inelastic, and funding stable. In the 2008 financial sector driven recession, health care spending stayed pretty constant while people were losing their jobs and homes. Maybe that gave some heath care investors the confidence they needed. Indeed, health care spending in the US has grown to be almost a fifth of our GDP. What bubble?

I doubt many of these analysts had spent a weekend covering the ER in a small Idaho hospital. For every broken hip or heart attack that needed those emergent services, there were ten rashes and colds that could have been treated in the office on Monday, or might have gotten better with some watchful waiting. But the way we have built our health care economy, the way we pay for these sometimes-vital services, requires all those runny noses and worrisome rashes to keep the money flowing so the nurses and doctors will be there when the car crash victim rolls in. With this pandemic isolation, the true elasticity of health care demand has been exposed. Will we go back to the good old days? Do we want to?

The job losses in health care are tragic as are the deaths from this novel virus. But so is wasteful effort. We have an opportunity now to build the system we want. But first, we’ll have to be honest with ourselves about just what we want.

Most people want what they want when they want it, and healthcare is no exception. Politicians know what we Americans want from healthcare. We have had two Presidents in a row promise us just that. Remember Obama: “You can keep your doctor…”? And now Trump: “If you want a test you can get a test…”. Fools love empty promises. Let’s stop being fools.

Hospitals nation-wide are feeling the cash crunch as elective procedures are postponed and emergency rooms waiting rooms are empty. Small hospitals, always closest to the margin are looking at buying red ink by the barrel.

This last weekend, around a fire pit, safely distanced, I heard a novel suggestion from a friend. He and I are in the same high risk, older male age category. He suggested, to save our local, small-town hospital we set up a schedule amongst our similar risk factor friends. Each of us, on separate days would go to the ER and complain of chest pain. We’d get the full-bore treatment, labs, EKG, maybe even spend a night there. The hospital could bill Medicare for our services and the local institution would be saved. We all laughed, even though it’s not really funny.

The years of growth in health care spending in the US has long been held to be unsustainable. The causes, the blame for this predicament are worth understanding if we expect to turn it around.

I sincerely don’t recommend setting up a chest pain schedule with your older buddies to save your local hospital. But I do ask you to start having some considerate conversations about just what healthcare should be in this country. It’s way past time we made the effort.

About ddxdx

A Family physician, former county coroner and former Idaho State Senator
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