This is my fourth “health care is different” post this week (links to first and second and third). What I forgot in the others was this: the ultimate “product” we attempt to buy with health care spending is health, not health insurance, not health services, but health. The important thing that follows is that the quality of health, unlike that of many other goods and services, is not just a function of that for which we directly pay. It isn’t a function only of the characteristics of health care providers or of health care insurers. It’s also a function of your personal characteristics.
That is, whether you experience good or poor health outcomes depends, in part, on things about you, as well as things about the care you receive. That makes health care very different from many other products and services. (I can think of a few others that also have this dependence on personal characteristics. As a weekend exercise, I’ll let you ponder.)
That’s also exactly why health policy is hard. How much about individuals ought to be considered when crafting policy? How responsible can and should people be about their health? Do the unhealthy get penalized because their lifestyle contributed to their condition? Or is their circumstance the result of random events over which they had no control (and, so, you could be next)? Of course, it is some of both. But what does that mean for subsidies, for insurance design, and so forth?
Health care is not like buying a cell phone. There’s nothing about you that changes the nature of the quality of the cell phone. It’s got specs. They’re invariant to who picks up the device. But two people who get the same operation from the same doctor could experience very different outcomes leading to very different down-stream costs. What do we do about that? Who pays? And why? These are not simple questions.