I get that lots of people just want to get rid of Dubya, but is there really anyone out there that finds Hilary Clinton more charismatic than a dirty sock?

A little over a month ago I began what will tonight be the third part of a four part series on the U.S. Healthcare System. In these essays it has been my hope to engage in some simple observational exposition and a little analysis on various aspects of the health care system. In this third essay in the series I have set aside the topic of “Medical Facilities”.

Upon reflection, I’m not sure exactly what I intended to write about a little over a month ago on this topic. Of the four topics I have written on or in the future intend to write about, “medical facilities” seems probably the least “meaty”. What I mean by that is there aren’t a whole lot of insightful observations or hard-hitting analyses to conduct here: it’s a pretty straightforward topic. But, because I like to follow through with the goals I set, I will, indeed, write today about the medical facilities in the U.S. I’m sure I can figure out something at least mildly insightful to say. (I always do, right?!?)

I guess the first question to ask here is: How are they? I guess the answer to that kind of depends where you are. Although I admit my knowledge of medical facilities is rather limited, I know that there are all different types of medical facilities out there. Some are government sponsored clinics for the poor; others are corporate private hospitals that work for profit; others are sponsored by religious organizations; others are university training facilities; others are research facilities; and surely there are still other types I have left out. There is a significant diversity out there in terms of the medical facilities available to us in the U.S.

Depending on the type of facility, it is not uncommon that quality is based, at least in part, on that type. For example, research hospitals are known to be some of the finest, because they have extremely brilliant doctors/researchers working there on cutting edge medicine. State sponsored clinics, on the other hand, are probably the worst, because few doctors who went to school for the better part of their life want to make government-like salaries. Ultimately, just like everything else, it’s all about money. But then, we live in a capitalistic nation, so what did you expect?

Another factor is location. Even if you compare two of the same types of facilities, say two university affiliated hospitals – one in Boston at Harvard Medical, and one in Johnson City (Tennessee) at East Tennessee State University School of Medicine. If you can get past the unbelievably obnoxious Boston accents, then the first choice out of those two is probably the one you would pick, if you had to choose. Why? Again, because of money. Boston and Harvard are much wealthier entities than Johnson City or East Tennessee State. Thus, the Harvard facilities are almost certainly much nicer.

Of course, if you’re just going to the hospital for a few stitches, then none of this probably matters. Generally, the more series your ailment the more important it is that you go to a superior medical facility. Of course, the same can be said of cost – the more serious your ailment, the more expensive, generally.

And all of this makes perfect sense. This is likely why there are so fewer truly magnificent research hospitals out there – because there are few truly bizarre and difficult to treat ailments. Any hospital can treat stitches or a broken arm, because those are pretty common. Just like in business, supply and demand dictate our medical facilities as well.

The question, then, is whether or not this is acceptable. Is it okay that someone in rural West Virginia does not have as easy access to high-quality medical facilities that someone in New York City might have? I think so, because again, it would not make sense to put these super high-quality medical facilities all over the place, because the demand is simply not there. That would be an inefficient use of resources. If you have a handful of such facilities located in large metropolitan areas, those who need this care should be expected to travel there.

What about the money aspect? Is it okay that someone with a mediocre HMO does not have as easy access to a brilliant surgeon at a super high-quality hospital that someone with a high quality PPO might? Again, I would say “yes”. If you go back to my first two essays on the health care system, I explained there how the insurance companies paired with employer health benefits really do end up being somewhat fair in terms of what you get for health care. The person with the HMO hasn’t paid the same amount as the person with the PPO. How should s/he be expected to obtain the better doctor/hospital paying less?

I know there are those out there who believe that medical care is an unalienable human right. Though I find that claim somewhat bizarre, even if one does believe it, then there is still no issue with my conclusion above – both people in my example will receive medical care, it just happens that one might get better care than the other. If you re-figure your argument to be that all people should not only have a right to medical care, but that the quality should be the same for everyone, then you find yourself on a very dangerous slippery slope. The top 10% most brilliant brain surgeons out there can only perform 10% of the brain surgeries in the nation. So 100% of brain surgery candidates can’t possibly be expected to have equal care. So what do you do – disallow everyone from getting the better care? Of course not. Capitalism takes over, as it should. In any field the best of the best are rewarded/incentivized with a greater salary – why should medicine be any different?

While some may find it disturbing that economics has crept into the practice of medicine, I find it inevitable, and even a little comforting. It provides a nice framework for determining how to distribute medical services/resources. After all, economics is the science of the distribution of scarce resources, and medical care is such a resource. Of course, if you believe that socialism is more favorable than capitalism, you’ll reject my conclusion. But that’s because you have a fundamentally different view of economics, not because you think it’s wrong that economics effects the practice of medicine.