A horse, a horse, my Kingdom for a horse - William Shakespeare, Richard III
In this famous, semi-comical passage, Shakespeare says more about the economics of healthcare than all of the textbooks ever written. The ironic truth King Richard articulates is that value of something fluctuates dramatically with circumstances. When life itself is at stake, something of prior enormous cost can instantaneously be rendered worthless(his kingdom), while something inexpensive becomes priceless(a horse).
This discontinuous type of valuation may be unique to medicine. For example, for a healthy person, the local trauma surgeon has no economic utility. However, once in an accident, that same surgeon is of infinite value, and the transition can occur within seconds. After the surgery, the calculation reverts back to baseline.
One could argue that large portions of the medical care practiced in the country is worthless. Most of the time, money and effort spent on doctor visits and testing done on healthy people does little but reassure. However, the occasional discovery of a treatable problem is of immense benefit.
The closest analogy I can make is national defense. In times of peace, a standing army is a huge waste of manpower and money, but if a war arises quickly, it's invaluable.
Items like cars, food, clothing, gold and stocks do not have this type of economic discontinuity. Their value fluctuates, but does not rapidly alternate between zero and infinity. Economists, politicians, and healthcare administrators do not understand these concepts. Much physician discomfort with outsiders attempts to control medical care stems from a poorly articulated appreciation of the difficulties expressed here. The fact that disease is frequently random, unpredictable and unpreventable adds to the confusion. It appears we will need an entirely new way to think about the value of healthcare, much like the difference between classical physics and quantum mechanics. I will pursue some of the themes here in future blogs.
I will be hiking in the Sierra for the next few days, and won't be posting.
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