Stephen Feman
The recent Massachusetts election confirmed the fact that the health care debate is far from over. The people in the one state where every citizen nominally has health care insurance have extended their influence to the health care of the nation. Those voters may not have been addressing that issue alone, but their actions will have some effect on us all. Interestingly, depending on one’s political perspective, anxiety had been expressed about every plan being brought forward, not the least of which was the concern about the potential effect of these proposals on constitutional liberties. That may no longer be a problem. Nevertheless, even if another alternative is developed, the evolution of the discussion has helped us all.

In our open free society, there is a benefit associated with the debate itself.  Some see an increased awareness of these health concerns as a potential stimulus for continued economic growth. As we know, the United States is in the midst of a profound demographic change. There has been an aging of the population characterized by an increased proportion of persons aged 65 and older. The Congressional Research Service’s demographic charts reveal a great upsurge in the number of older people in this country. By keeping that population healthy, we should all benefit from this preserved human capital. By improving the health and well-being of the generations to follow, additional benefits accrue. As others have indicated, “the accumulation of human capital—in the form of increased knowledge and skills and improved health and longevity” will continue to play an essential role in the economic growth of this country. My contention is that making people aware of these issues has offered some benefit to our society, regardless of the outcome of the debate.

If the investments in American health care that already exist work as expected, there should be a measurable improvement in the long-term functional status of many citizens, both young and old. Not only will the Medicare generation continue to receive benefits, but people that are newly aware of these issues will have a better chance of a healthy life extending into their old age. With many people continuing to be healthy, a small part of the future demand for health care may become reduced over time.

But there is another activity occurring, one discussed less often. In many cases, as people grow older, they continue to work and contribute to the GDP. This had been noted in the past, but few paid attention to it. However, even before people were aware of the developing “sea change” in American health care demographics, there was an increase in the proportion of the workforce older than age 65. Most of those workers are people who are not obligated to work because of reduced economic circumstances. Instead, these individuals have chosen to continue on their jobs, and contribute to society in other ways, because it gives more meaning to their lives.

Going forward, one expects still another “sea change” to develop as a result of the health care debate, but this would be in the doctor-patient relationship arena. What had been a paternalistic situation, with the physician in the role of an all-knowing father, is in the process of shifting. When most patients are older (and more experienced) than their primary care providers, physicians will need to explain their activities in greater detail. The Internet has created a standard of health care knowledge that is free and open to the public. As a result, at every patient interaction, physicians will have to show that their expertise is greater than what one can look up online. Otherwise, why would a patient want to participate? That is, the doctor encounter has to continue to be a “value added” experience that the patient can measure.

At present, from an economic perspective, the prices of health care are not informative, and consumers cannot use dollar-related data to compare physicians and/or hospitals. The existing problem of health care information asymmetry has kept patients at a disadvantage.  Reforming that situation may be an added benefit developing from within the current discussions. This seems to be included, to some degree, in every version of the health care bills. No matter on which side of the aisle one sits, everyone appears in favor of improving knowledge.

About the Author

Stephen Feman