Health care “reform” advocates are fond of claims that such-and-such number of people don’t have “access to” health care.
Effective phrase, and sure seems to support their case. But what does it even mean? What is “access”? It’s a pretty slippery notion to anyone who actually takes the time to, well, think about what it might signify.
At one extreme end of the spectrum, one might say that “access” must be free and unfettered to be true “access”. If you have to fork over money for entry somewhere, you don’t have access to it. If you had access to it, you’d be able to go there, and do the thing, without someone forcing you to fork over money. By this reading of “access”, it almost necessarily entails “free”. So if people “not having access” to health care is a valid complaint, and this is what “access” means (free), the complaint is essentially a demand for health care to be free. For everyone, I assume. (After all if it’s free for you what’s the argument that I should pay anything? There isn’t one.) In other words it’s an argument for fully socialized health care.
The other possible meaning, of course, is that “access” doesn’t quite mean “free”, it just means “affordable” – there may be some cost, but it isn’t a cost that exceeds one’s ability to pay. This definition of “access” is superficially appealing (according to it one might say I have access to a Toyota, but not to a Lamborghini, which sounds right). The problem is that by this definition, there will always be some subset of humans who “don’t have access” to any good or service you could name. There’s no such thing as a good or service that (a) isn’t free but (b) every single human can afford. Whatever price X you can name, there will always be some humans who can’t afford to pay X – and thus, “don’t have access”. So if this is what the complaint about “access” means, it’s not a valid complaint.
In summary: if the complaint has merit, it’s a veiled demand for socialized health care. If it’s not a demand for socialized health care, it’s a complaint without merit.
There is another dimension to the ambiguity surrounding “access” though and that is simply the fact that “health care” is not an unambiguously-defined service. What exactly is “health care”? To some people “health care” means “set my bone when it’s broke”. To other people “health care” means “I feel a twinge in my elbow so I made an appointment with my doctor”. There is often no simple, easily-defined concept of The Health Care Stuff Someone Needs. Instead there’s a fuzzy continuum of possible Health Care Treatments that may (or may not) work on someone’s ailments. When trying to ensure that everyone has “access” to “health care”, how high exactly must one climb this spectrum before “no access” becomes “access”?
Let me illustrate with an example. Cancer is often treated with external-beam radiation (XRT), and has been for some 50 years now. But within radiation therapy of cancer there is a specialized technique, a special form of XRT, called Intensity-Modulated Radiation Therapy (IMRT). IMRT was invented in its current form in the 1990s, more or less. It requires special software to optimize one’s treatment, and the radiation machine (linear accelerator) needs to be equipped with the right add-on gear and whatnot to be able to deliver it.
The difference between XRT and IMRT is sort of like the difference between attacking your cancer with a shotgun and attacking it with a sniper rifle. That exaggerates things, but you get the point: IMRT is more focused, and hones the radiation more tightly right where you want it (cancer, not health tissue). As a result IMRT can be expected to lead to fewer side effects, and by the same argument, using IMRT one might expect to be able to zap cancer more with no higher risk.
I should add that last time I was keeping up with these things, the reimbursement (from Medicare, if it covered it, or insurance companies) for getting a course of XRT was measured in the low thousands, whereas for IMRT it was in the low tens of thousands. Those numbers are highly approximate and I may be remembering it wrong (and these numbers may have converged in recent years) but it was definitely the case that IMRT is some multiple more costly to deliver than XRT.
With that setup, let’s try to apply this example to the issue of whether someone has “access” to “health care”. Say someone is a cancer patient. They need treatment. Cancer treatment is “health care”, and obviously, that’s what they need. And we are very concerned with ensuring that this person has “access” to it (the “health care”).
But wait: what IS “health care” for this person? Ask the radiation oncologist and he says a standard treatment for this cancer would be XRT. Or, one could opt for IMRT.
Which treatment is “health care”? Are they both “health care”? Suppose this person (or his ins. co.) will pay for the $2000 XRT treatment but would have trouble affording the $20,000 IMRT treatment. So he ‘only’ gets XRT. Does he have “access to” “health care” or not? Maybe he does (because at least he got XRT). But wait, look at that dude over there, his ins. co. shelled out for the IMRT. That’s not fair! He’s getting “access to” that health care which other people are not! But keep in mind, IMRT didn’t even exist prior to the 1990s. There was no such thing as IMRT. When exactly does it join the ranks of Treatments That Must Be Applied To Everyone Or We Have An “Access” Problem?
And it doesn’t end there, either. Because hold everything. IMRT, you say? That’s sooooo 1998. The new thing is Stereotactic Radiosurgery.
Wait! The new thing is Tomotherapy.
Wait! The new thing is proton therapy.
If we don’t subsidize proton therapy for every single human in the U.S. who has vaguely proton-therapy-treatable cancer, isn’t that an issue of “access”?
Surely you can see the slippery-slope here. It’s not at all well-defined to anyone who knows even a little (as I do – a little) about how these things work. There’s no simple cookie-cutter treatment you can slap the label “health care” on. The answer is obviously they’re all “health care”. It’s just that some treatments are Toyotas while others are Lamborghinis. Which one are the health care “reform” advocates insisting we must buy for everyone? Where do they draw that line (if they’re even aware of it)?
But if they were aware of these issues, they wouldn’t oversimplify things or speak in terms such as “access” in the first place. In other words, they wouldn’t sound as ignorantly propagandistic as they do. So in a sense, my questions here are moot. They answer themselves.