Health Care and Politics

Now that the Presidential Election cycle is starting up again in earnest, we will no doubt be bombarded with schemes on how we can "improve" our ailing health care system. Candidates will come up with all sorts of amazing ideas of how we can both provide coverage for everyone while at the same time reducing the cost of health care in this country:

I have a dream. I have a dream of a nation where health care is a right... just like our rights to life, liberty, and the pursuit of happiness. I have a dream of a nation where the everyone will have access to all of the advanced medical procedures that this great country has to offer, without some insurance company telling them what they can or cannot have covered. I have a dream of doing this without raising the cost of doing business in this nation, so that our companies and employers aren't forced to move labor offshore due to rising health insurance premiums.

Of course, that is the type of snake oil which sounds good on the campaign trail but has about a snowball's chance in hell of happening. So you are going to provide better health care to more people while spending less money? Sounds like you are living in a dream world.

There is a metaphor in engineering known as the "tradeoff triangle". It is a triangle that has three sides labelled "schedule", "cost", and "quality". You have the ability to control two of the three sides. However, once you choose two of the sides, the third side is determined for you by the geometry of the problem. For instance, you can choose a schedule (ex: "I want it done by the end of next month") and a cost (ex: "I want it to cost less than $1 million"). However, if you do that, then your quality will suffer. On the other hand, if you want to choose a schedule and a quality level (ex: "Must work perfectly the first time"), then it will cost you a lot to meet such a schedule and level of quality. This is a classic trade-off when designing a system. Normally, a smart project manager will ask his users: "You can have schedule, cost, or quality. Pick two."

Health care has a similar tradeoff triangle: "coverage", "cost", and "quality". You can choose two of these properties, but once you do, the third is determined for you. If you want to give everybody the highest possible level of care, then you can expect that the bill for this will be very high. On the other hand, if you want to give everybody coverage for a reasonable price, then you might have to lower the quality by rationing health care. Unless there is some sort of miracle breakthrough, the fact of the matter is that you cannot give everyone high quality care at a low price. Something's gotta give!

Unfortunately, it is very tempting for politicians to promise just that when they are on the campaign trail. It is an appealing message that is certain to get votes. However, the discerning voter (which are very few and far between it seems unfortunately) will see through the smoke and mirrors to see this empty promise for what it is.