Healthcare: Good, Fast, Cheap. You Only Get Two. | Guest Author, Steve

Capitalism brings Americans an abundance of products and our mindset is very clear. When it comes to purchasing we want everything good, fast, and cheap.
Think about it.

  • We want high quality—good.
  • We want it readily available—fast.
  • And we want it affordable—cheap.

But there is something I don’t think we realize. You see, in nearly all of life, you can only have TWO.

Never THREE.

ONE is always sacrificed.If the product is good and always available, it will not be cheap. If the product is fast and cheap, it will not be good.
Think about McDonalds or KFC. The food is fast and cheap but not very good on any culinary scale. Think about out-of-season citrus. It is good and available, but it is not cheap.

The Palm (restaurant)Ever heard of a restaurant called The Palm? There are several in the United States and they have a reputation as one of the finest. The food is exceptional {good}, and its served in a timely manner {fast}, but since it’s prepared fresh to your exact preference from the finest ingredients, it’s expensive {not cheap}. When it comes to any restaurant, my wife and I agree—you get what you pay for.

We may not like it but we’ll automatically accept a price if the goods meet two of the qualifications, never even realizing we didn’t get all three.

And this is a very important aspect that is about to affect our lives deeply.

Morsani Center for Advanced Health Care

It’s regarding healthcare.
And this is the little secret that no one wants to discuss.

  • We want all three.
  • Our politicians are promising all three.
  • But we can’t have all three.

The American healthcare system was built on the premise that healthcare should be the best possible {good} and should be instantly available {fast}. By the above definition, we know it has to be expensive {not cheap}.

To carry out the goal of less expensive healthcare, we must accept a reduction in quality or availability {bad/slow}.
If you want to keep it cheap, quality must decline. A cheaper system rewards doctors less pay. This discourages the best and brightest from choosing medicine as a career. The debt burden is just too costly. At this moment a new graduate doctor will not pay off medical school loans until age forty. From a practical standpoint, who will choose medicine as a career?

Another result is it discourages industry from developing innovations to improve healthcare.
Cuba has a health care system that is an example of cheap and available but the quality is substandard when compared to the United States. There are procedures and surgeries totally unavailable. I recently offered to go to Cuba to teach a procedure that is readily available in the United States. They were interested but don’t have the equipment nor has the procedure ever been done in the island nation. Innovations have been totally absent from this nation for decades.

Canada FlagAn excellent example of the good-but-slow approach is Canada.
Overall, Canadians have good healthcare, but they often wait months for solutions that would occur quickly in the United States. The healthcare products retain quality and the price is cheaper. But the natural byproduct is shortages, creating great frustration. If this were not the case, Canadians near the border would not cross into the United States for surgical solutions to their problems that would otherwise take months to get.

For example, a woman with a rotator-cuff tear needed an MRI. Her appointment was one year away. Then surgery would be another year off. She came to the United States and had everything done in one month. At age 71 she continues her hobby as a long-distance cyclist. Incidentally, her husband died of colon cancer due to the Canadian system not covering colon screenings.

Another concern are further pay cuts to hospitals and physicians.Doctor's Office (Tools of The Trade)
With universal healthcare a government has to cut expenses in several ways. A big way they do this is cutting reimbursement to physicians and hospitals. When government sets a fixed price for a hospital or doctor, expecting the same quality, the only option is less available healthcare.

This already occurs in our system with Medicare and Medicaid. Medicare patients without a primary care physician have problems establishing themselves in a new practice. Medicaid patients are not seen in certain practices or there are limitations on the amount seen.

In the end, this will drive many hospitals and doctor’s offices out of business.
Clearly, with the upcoming deeper pay cuts, some hospitals will have to close and surveys have demonstrated that up to 40% of doctors plan to stop seeing Medicare patients. Like many other physicians, I love the relationships I’ve built over the years with my patients. But the planned fee schedule cuts could make it impossible to deliver the same personalized care that so many of us want to provide.

To stay in business, changes will have to take place and this will impact either quality or availability. What a disappointment to both of us—the providers and the patients.

Controlling healthcare costs is a great idea.
Unfortunately, it will have a natural outcome of either decreasing quality or availability. Price fixing in any market results in reduced availability or quality. Either can be acceptable options as long as people are aware of what’s coming.
But are these acceptable?

To pretend we can have high quality healthcare that is readily available and affordable is disingenuous.

Unfortunately good, fast, and cheap cannot coexist.

At the very least, we deserve honesty from our political leaders.


Daily Post: Health Care/

Photo credits:
The Palm Restaurant website
Morsani Center for Advanced Health Care website
Canada Flag: Michael Yat Kit Chung
Doctor's office tools of the trade: public domain
Other photos by Alexandria Sage
Leave a comment


  1. Just an observation – if at the moment (pre-Obamacare) the US health system is of high quality then why does the US have relatively poor life expectancy compared to other countries ( ? About the same as Cuba apparently…and less than the UK that has a cheap healthcare system. If all US citizens get healthcare then would this bump up the US in the table do you think?

    • Here is my reply to your first comment, which seems to address what I will call optimal health.
      High quality, available healthcare does not equal optimal health. Many factors contribute to a person’s health and one would have to study each one, in each country, not the least of which is genetics. America is a very diverse country and we have access to many lifestyle choices. So personal responsibility factors in, too.
      I strongly advocate healthcare prevention and maintenance. See
      The philosophical argument in my article states that good, fast, and cheap cannot co-exist. I guarantee in each country you name, if you study each one thoroughly, one is sacrificed.

    Cheers & peace!

  3. If the Europeans can find a way to provide good healthcare that is affordable for the masses, then so can we. Affordable care doesn’t mean that the wealthy cannot continue to get private, expensive care if they wish… They can. The fact remains that healthcare in the US is exorbitant. No one should have to go bankrupt to pay for their care… There is something wrong with that picture. Let’s all work together to make this a positive experience for America. 🙂

    • I know. I deferred it to my guest author, Steve, since he’s well-travelled and knows more about European healthcare. He’s had an exceptionally busy schedule and wanted to put some thought into it. Waiting for him to slow down just a bit. But we haven’t forgotten. I promise to get back with you. I’m apologize as I should have let you know your comment was read and taken seriously.
      We’ve discussed it, though, and it’s just more complicated than one might think. I will get back with you.

      • It’s okay Alexandria as I wasn’t looking for an argument or answer per se. I was simply making an observation based on experience. Remember I grew up in Europe before moving to the US? I know both health systems well and have experienced the ups and downs of both… I remain an avid supporter of Affordable care from a humane standpoint. If you’ve ever held a minimum wage job and paid $150 for meds you can get for $5 you’ll understand. Affordable care should not be a point of contention in one of the wealthiest, industrialized nations in the world. Thank you for following up with me. 🙂

        • Point well taken. I like your words “affordable and humane”. Though our healthcare system is far from perfect, the answer is not a multi-thousand page piece of legislation that puts our healthcare choice at the mercy of bureaucrats in Washington. As the law goes into effect, it will prove to be the largest tax in American history with the worst payout to the American taxpayer.
          I truly believe in healthcare reform. A non-partisan discussion about solutions was long overdue. The Affordable Care Act is not that solution. Our politicians are making promises they cannot possibly keep.

        • One more thing—I ran across this article and thought it very interesting. This is the kind of creative thinking we need. Let me know your thoughts.

  4. katarzyna00

     /  November 11, 2012

    Although this post follows a fun lighthearted post I found it just as easy to read. Easy to read and so so true. We do want all three and are often given hope that we can have all three. So obvious now that I have read it. Nothing is good fast AND cheap.

  5. You know, my last comment is still in moderation. 🙂

  6. I live in the UK and there are problems with the health system – long waiting lists for certain operations, cleanliness of some hospitals, etc. But the one thing you don’t have to worry about is NOT getting treated. If you collapse in the street you will be picked up by an ambulance and treated in hospital without being asked for an insurance number, credit card number or whatever…which happened to my aunt who lives in New York and nearly was left untreated (and would probably have died).

    • Greetings,
      I have received both of your comments and had them held for moderation. I will release the other one with a basic opinion reply from me. But this one I will defer to my guest author, Steve, since he is a physician who has taught in many countries, and understands the complexities associated with the U.S. healthcare system verses other countries.
      However, I am am R.N. with a background of 15 years Emergency Dept. experience and I will address what happened to your aunt. I am completely perplexed by what you say happened to her. Under EMTALA, which is federal law, every person is to be taken, treated, and kept hospitalized until their medical condtion deems them to be released, without regard to insurance or ability to pay—if the hospital is a participant in the Medicare/Medicaid federal program. And most are. I can’t imagine a New York hospital not being a particpant. Here is a Wikipedia link about EMTALA.
      This is not to say that she will receive no medical bills post-discharge. And hospitals do have collections and billing, who will track patients down. But most of the time they will work with them on some kind of payment plan, or assist them with getting some kind of government assistance.
      So I would need some clarification on the details. If it occurred after 1986, then the medical providers would be in violation of federal law.
      All of that said, I will say Steve is putting a lot of thought into comments received. But he is a physician as well as a medical instructor and speaker, with a busy family life. You can imagine his time contraints. But I reassure you he is putting thought into this. It may turn into another blog post.
      We do want you to know we really appreciate you taking the time to comment and give us some perspectives on your own experience. It provides for a very interesting discussion on this topic. And if there is anything this topic deserves, it is thoughtful, objective discussion.
      We will get back to you. Thank you for your thoughts.
      Alexandria, (for Steve, too.)

  7. Brilliant post.
    Though the UK does have quick (if you really need it) healthcare as well as being high quality (personal experience talking), it’s all included in taxes. Sure we have higher taxes to be able to afford the NHS but to me it seems a better system than the US where insurance policies don’t always cover everything. I dread to think how much my continuing treatment (for chronic illness that will be with me forever) would cost in upfront fees in America. My parents probably couldn’t afford it and I’m only 19. I’m happy to pay for my treatment in future years when I’m working but overall I believe the NHS has done the best job possible (something I’ve actually posted about) and personally I don’t understand Americans resistance to help others out in times of need (I suppose I am biased though). 😀

    • I appreciate your comments. However, I would like to address a couple of things. The higher taxes to pay for healthcare in your country are in keeping with the notion of expensive. So you have good (high quality) and fast (readily available) but it is not cheap. There are many other things that factor into high quality healthcare and it’s quite complex. For instance, what happens to incentives for innovation? How do you recruit the brightest and best to go into a field where they will be expected to provide high quality healthcare for everyone and receive reduced or capped payment for services and be expected to carry a heavy workload? Another thing is personal responsibility and wellness. Obesity is a huge problem in America and yet diseases directly related to obesity are costing millions. These are just things to think about that I pose to you since you are not yet a taxpayer.
      The other thing is the general statement that American’s are resistant to help others in times of need. I know you did not mean this in a negative sense but there’s a few things you may not realize. You may not know much about our healthcare system here but all of our poor, elderly, and handicapped are cared for with Medicare and Medicaid. To say Americans are resistant to helping those in need is just not true. What we resist are the exorbitant taxes associated with our new healthcare law. Reform is necessary. This new law is not. No one can afford it, not even our government who signed it into law. It was the wrong answer to the healthcare problems we face here. Our healthcare system hurts the middle class more than anyone. We bear the brunt of the huge taxes.
      Anyway, I hope this sheds more light on the whole subject for you. We need to seek true and honest answers for the problems facing healthcare.
      By the way, read the above comments by rudehealth, who is from the UK. Apparently, for elective surgeries and tests you have to wait a long time. Not so here in the U.S. You can get in for testing and elective procedures very quick. Just another thought. I appreciate hearing your perspective.
      Thanks again for your comments. I look forward to reading your blog some time.

      • When you have higher taxes from the start it doesn’t seem as expensive as it would if you’re in the generation where taxes skyrocket. Also, the NHS is no longer completely collectivised, certain aspects are privatised through marketisation. There are private research companies so that’s innovation and even doctors who work in the NHS are well-paid so it pays to get to the top.
        I know waiting lists can be long but if your issue is urgent space will be made. I admit when I was first ill GPs were annoying, they kept on about eating disorders and so we had to get a second opinion at hospital but as soon as I spoke to my current doctor I had tests, x-rays etc within one week and now I have to have infusions the first one was arranged as soon as blood test results said it was ok. You do have to pro-active if you believe you should be bumped up the list but this is the same whatever the system. I read the other day that 30% of patients in the UK don’t have to be in hospital and it’s the community care which needs addressing so perhaps that’s the answer to waiting lists?
        Obesity is (usually) a self-inflicted problem and educating people etc would help. I don’t agree with the NHS paying for surgery to help people loose weight (unless they have a medical condition).
        Thanks for the extensive reply 😀 And I don’t mean to insult American attitudes (though I am stereotyping) but I’m going on interviews I’ve seen on TV and in my Politics class.

        • Once again, I so appreciate you stepping into this discussion. Sorry I’m just now getting back to you on this one but I wanted to put thought into this to give you a more educated reply. So here goes.
          First of all, let me caution you to be wary of the media and college professors. Most colleges and the media are now slanted toward a “big-government” socialist attitude rather than one of freedom and personal responsibility. There are many proofs of this. Do investigative work on your own. Form your own opinions based on your own investigative work rather than what you hear on the news or from your professors.
          As far as American culture I hope someday you can visit this country. Though diverse, Americans are the most generous people on earth. We take care of each other and people from other countries, too. We have our differences and we are a bit crazy sometimes but everyone that comes here loves it. Otherwise, why would so many people keep coming here from other countries to live and work and raise their families? You can’t even trust the American media anymore so don’t form your opinions on that either.
          Now, as to the issue of taxes—I’d like to draw your attention to two articles on my blog. I encourage you to read the referring articles listed at the bottom as well. Perhaps you will see why taxes are such a point of contention here. It is truly way out of control. Let me know your thoughts after your finished.


          • Taxes are under scrutiny all the time everywhere, you’ll never find a system everyone’s happy with.
            Seeing as my teacher was a member of the Labour party, yes he’s going to be socialist. However, to be fair to him he was careful in teaching both sides of the argument and there was a guy in my class who was fiercely conservative – interesting debates followed 😀
            Got nothing against America really (or Americans) but I’m afraid I’m quite typically ‘British’ and I’m likely to stick to our slightly more ‘socialist’ system. 😀
            Will read those articles in a minute 🙂

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