Todd Wilemon, a managing director at NYSE Euronext and a regular Fox Business commenter, was foolish enough to do an interview on health care with The Daily Show (a program about which I had a bit to say over the weekend), and the results are approximately what one would expect, which is to say, he came off like an inarticulate jackass. The headline quote came when Mr. Wilemon was asked about what poor people who cannot afford health insurance should do. His answer: “Stop being poor.”
For that, he is being treated as the second coming of Marie Antoinette (the cartoon Marie Antoinette of the class-warrior imagination, not the actual Marie Antoinette), and held up for sundry scorn and general ridicule.
His diagnosis is absolutely correct.
But first, a little bit about that Daily Show
segment. Mr. Wilemon was discussing health care, specifically the likely consequences of the Affordable Care Act, with Daily Show
correspondent Aasif Mandvi, the unthinking man’s Sasha Baron Cohen, who ambushed him with a report about a charitable medical organization that was founded to deliver health-care services in remote parts of the world but now does the great majority of its work here in the United States — in the case of the Daily Show
segment, in Knoxville, Tenn.
The fact will not occur to the sort of people who watch The Daily Show, but the persistent lack of access to good health care among poor people in the United States is evidence more for the case of conservative health-care reformers than for Barack Obama and the cruelly misnamed Affordable Care Act. Specifically, it is evidence that we have not learned the critical lesson of Medicaid: Appropriating a certain amount of money and labeling it “health care for the poor” is not the same thing as providing poor people with access to doctors, hospitals, and medicine. It is easy to move money from one pocket to another, which is how we manage to spend a figure approaching a half-trillion dollars per annum on Medicaid with very little to show for it in terms of better health outcomes for poor people. In Tennessee, Medicaid alone spends about $10,000 annually for every poor person in the state, and poor Tennesseans of retirement age or older already have access to Medicare.
We spend the money, but we do not get the health care.
The underlying fact here is: Dollars ≠ Doctors. There are many reasons for that. One is that appropriating money for health care does not exnihilate doctors, pharmaceuticals, or hospitals into existence; rather, it simply injects more money into the chase after the same supply of goods and services, which is a recipe for price inflation rather than one for expanded coverage. Second, it is a terrible program from the providers’ point of view, which is why medical professionals who have a choice increasingly refuse to take on Medicaid patients. Subsidized access to a doctor who categorically refuses to see you is of no benefit to poor people who need medical treatment. One of the critical shortcomings of the Affordable Care Act is that it doubles down on this folly: Its byzantine architecture of subsidies and mandates does not add to the supply of medical goods and services, and in fact probably will reduce that supply as it encourages owners of both human and financial capital to invest their resources elsewhere. A bright and driven young person with the intelligence and ambition to do the grueling work necessary to become a physician has more attractive career choices than that, and investors must certainly think twice about betting large sums of their own money on firms that will be under ever-more-picayune federal micromanagement.