The Two Generation Rule: Medicare and Geriatricians

There is a two generation rule for understanding the full effects of cultural changes: one generation to institute the change, another generation to grow up and react to that change.

We are now seeing this play out in geriatric medicine, i.e. the medical needs specific to the elderly.  (Hat tip: Glenn Reynolds.)   In the next fifteen years, we will need three times as many geriatric specialists as we currently have.  Even though there are more elderly people, and those people are living longer, there are fewer doctors specialising in this type of medicine. (Note: this is your first clue that the free market is not involved here.)

In 1965, Congress instituted Medicare, which provides health insurance for all Americans who are above age 65 (and some others).  Medicare reimbursements are notoriously low – approximately 35% less than what private health insurance pays – and are only dropping, not rising. (Folks, that’s a 29% drop in reimbursements that Congress wanted to put through.)  The shortage of geriatric physicians makes perfect sense, in the non-free-market of government-run health care: payments are lower than in the private sector, those payments are made on the whim of Congress, not by insurance companies who have some interest in keeping their clients, and the amount of paperwork is higher than for private health insurers.  All this adds up to a two-generation result: two generations after the passage of Medicare, we can’t find enough doctors to treat old people.

In 1936, the Soviet Union declared that access to health care was a universal human right.  Now, “[l]ack of access to quality health care is perhaps one of the most all-encompassing human rights issues facing [Russia] today,” despite having more physicians per capita than almost any other country in the world. Life expectancy in Russia is about age 65.

To anyone who thinks that state-run health care means fewer abortions (due to access to birth control) or more live births, due to lack of financial pressures, I will point out that Russia has one of the highest abortion rates in the world.  From that link, “According to one study, 14 percent of the women in Russia with sixteen or more years of school had undergone eight to ten abortions.”  Likewise, physicians in Russia are paid more poorly than their counterparts in the medical bureaucracy (hey, who would have expected that from a government-run programme?), and are in fact paid more poorly than most other professionals in the countryDoctors go through intensive schooling, then are retrained in other, more lucrative, professions.

Ergo,  Russia has a high number of physicians, but precious few who are willing to work for the government.  We are seeing that now with Medicare, and that is our future, circa 2050 or so, under ObamaCare. As Russian-born Ayn Rand said, there are only three ways of making a man work: a whip, a gun, or a dollar.  As I will say, you can have a right to someone else’s labour, but you can’t force them to work in a free country.


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Filed under Economics, Medicare/Medicaid, ObamaCare

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