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Monday, February 5, 2007

No such thing as 'healthcare'

By Marcelo Rinesi: Buenos Aires

The fundamental issue with the growing discussion over healthcare costs is that they aren't necessarily costs. After all, health (in its broadest, most inclusive sense) is one of the most interesting goods one might want to buy. And buy it we do -or try to, at least-, with everything from gym machines to diet pills to state-of-the-art interventions. It's a good that, to varying and not always clear degrees, we have decided to subsidize, but it is a good.

But healthcare is also an investment. Even without the disruptive effects of things like plagues, health problems cause all sorts of havoc, like workplace absenteeism and lower productivity (health problems during the first years of life, for example, impact negatively on lifelong overall productivity). And this is only one side of the coin: even nominally "healthy" (i.e., "not sick") people become much more productive -not to mention happy- with regular exercise, caffeine, and other biological interventions.

I've found that replacing the term "healthcare" with "biotechnology" is a very interesting mental exercise. I think it reflects better its economic impact and its technological dynamism (which doesn't preclude tech-free lifestyle interventions - biotechnology isn't always about gadgets). Also, it helps fight a very problematic bias: the idea that there is a nominal "baseline healthy" human, a "main biological sequence" which healthcare should confine itself to keeping us in sync with. First, if Homo Sapiens has a baseline life path, it's rather short, brutal and nasty, involving painful ailments and gruesome deaths that nowadays we (have at least the technical capability to) avoid. Second, our current concept of what "being healthy" means involves a host of cardiovascular, biomolecular and cognitive problems once you reach your seventies, eighties or nineties. Thinking that there isn't nor will be any demand for something better is the biotechnological equivalent of "640K of RAM ought to be enough for everybody." It wasn't and this won't, neither for individuals, their employers or their countries.

This probably universal demand for emerging biotechnology will, I think, make aging societies more economically dynamic than they otherwise would be, with rising demand curves as technology makes new goods available, and as future productivity expectations shift, incentives for saving will decrease. But healthcare/biotechnology markets, highly politicized and subsidized as they are, must work right in order for this to work out and, most importantly, we should stop thinking about "healthcare" and keeping people "baseline healthy", just as we don't think about the automobile industry as giving people their "baseline cars." I do think the state should help people have access to biotechnology -for ethical, societal and economic reasons- but forcing everybody to get "just enough" will hurt what could could become an economic driver -especially for developed, aging nations- as strong as information technologies have proved to be.c