The Human Cost of Healthcare

To say healthcare is hard, regardless of what aspect of it you're discussing, is an understatement of incredible proportion. It doesn't matter if you're talking regulation, measuring treatment outcomes, economics, or any other angle you want to tackle. Healthcare policy is unquestionably near the top of the list when it comes to complicated topics.

Single payer and universal health care have been raging subjects the last few years, and especially with today's CBO score of the reprehensible Senate bill meant to repeal and replace the Affordable Care Act. It would be easy to give in to writer's sprawl and let the focus of this article wander in that direction.

And that's the problem in a nutshell. Any time an issue with the complexity of the healthcare debate--whatever that debate might be--begins, the complexity of the subject predictably leads to countless detours and caveats touching on one of a hundred wonky policy details.

You see? Even the act of prefacing an article meant to focus on a single aspect of just healthcare economics required three paragraphs. Before we dive in, let me say that as an end policy goal, I am very much behind some form of universal coverage/access. I also understand that getting there will require an incremental approach. There are thousands of supporting facts that can demonstrate why this is true, but we'll pick just a single one today.

The Human Factor

Everyone talks about the obvious parts of controlling healthcare spending when universal coverage proposals like Medicare for all are brought up. Reducing drug prices (complicated!) or medical device/supply payments (also complicated!) are the red meat of the debate. Yet one of the largest slices of the economic angle is roundly ignored. My suspicion is that no one wants to talk about it because it will make them sound callous.

That subject: payrolls.

Lots of people complain about the money doctors make, and whether those complaints have merit or not, the discussion nearly always ignores those in the medical profession who vastly outnumber physicians. Nurses, nurse aides, phlebotomists, lab technicians, physician's assistants, or countless other medical professionals. And let's not forget the other staff, from janitorial to security. The cost of your medical care at a hospital pays all of them.

If that seems like stating the obvious, I agree with you. Yet this simple fact is completely overlooked in almost every debate we have about the sort of harsh cost controls needed to create truly affordable universal coverage. Nurses, for example, tend to make what both of my nurse parents have always referred to as 'good money.' Nurse aides, less so. This much I know from having done that job for several years.

Which isn't to say nurses shouldn't be well-compensated for their work. It's a difficult job that requires a lot of precision to do well, and mistakes can take lives and end careers. The field is always hiring, always in desperate need of new bodies to cover shifts. It has been this way my entire life; a perpetual state of shortage.

To bring healthcare costs down to sane levels, we would have to enact the usual cost controls on things like medication and medical supplies. But when the hospital charges $100 for an aspirin, some of that money goes to cover payroll. It's as simple as that. This is not a defense of the many egregious examples of naked greed in healthcare, but an example of how the different strands of economics inside it are tied together in ways we may not be able to separate.

As a nurse aide, I made about $25,000 a year. As my spinal surgery can attest, it is not an easy job. The night shift at my nursing home had me caring for 20 patients at a time. Checking, changing, taking them to the bathroom, and many other jobs that added up to eight hours spent running full tilt.

If we're being intellectually honest about containing healthcare costs, then pay freezes leading to pay caps have to be on the table. Just as we as a nation have discussed limiting what we'll pay manufacturers of medical devices and drug companies, the people who provide our care are just as much a part of the equation.

What would happen if even a temporary freeze came into effect? A guess based on my own experience tells me that it would become that much harder to recruit people into nursing programs, CNA classes, and a host of other necessary fields. My own mother encouraged me to go into nursing for most of my life because of the economic stability and opportunities the job offered. Reduce those incentives and you risk reducing the number of people willing to enter the field.

And that's just the people directly employed by healthcare entities. Consider the effect of cost controls on medical device and supply manufacturers. Implementing those controls is far more likely to impact the factory workers who produce them rather than the stockholders and company officers of a given corporation.

None of which is to say that these are things we shouldn't do. I would argue the opposite, in fact. We absolutely have to discuss them and work out slow, incremental approaches to make the necessary changes. The current arguments over universal healthcare are terrifying because the most vehement supporters, who are the most visible and vocal, completely ignore the million tiny details that need careful consideration.

It's easy to crow about how other nations provide universal coverage, but most of the time people ignore the problems those nations face. They aren't frictionless systems. Like any complex structure, universal systems from Australia to the United Kingdom require constant maintenance. The idea that we can simply switch from our current system to a drastically different one is dangerous.

I mean that word: dangerous. Like anything in motion, American healthcare carries huge momentum. Sudden disruptive changes that aren't implemented over time can have disastrous consequences. That's why many of the changes in the Affordable Care Act were tinkered with over the course of decades. It's why the ACA was publicly debated for more than a year. It's why countless healthcare experts were brought in. To ensure the implementation of new rules and systems didn't crash the whole thing.

Universal coverage that is affordable and effective should most definitely be our end goal. Doing so means taking a hard, honest look at every possible piece and part. Payroll costs are just one thread of the economic aspect, which itself is just one thread of dozens in the overall debate.

Part of why the Senate bill is so dangerous is because it takes a hammer to many of the delicate moving parts of the American healthcare system. To pretend that a sudden, ill-considered shift in the other direction wouldn't carry risks just as grave does a disservice to everyone who fought to make the ACA a reality.