Robert Samuelson has a fabulous column in today’s Washington Post about the true cause of the health care crisis in America; and, as he points out quite well, we need look no further than the mirror to find whose to blame.
Almost everyone agrees that we ought to “fix the health care system” — a completely meaningless phrase despite its popularity with politicians, pundits and “experts.” Indeed, it is popular precisely because it is meaningless. The people who proclaim it rarely tell you the discomforting choices it might involve. Instead, they focus on a few specific shortcomings of our $1.9 trillion health-industrial complex and imply that, if we correct these often serious flaws, we’ll have “fixed” the system or at least made a good start. This is rarely true, and so most forays into “health reform” end with disillusion.
We are about to start the cycle again. By most accounts, President Bush plans to highlight health care in his forthcoming State of the Union address. His proposals may or may not have merit, but they surely won’t fix the health system in any fundamental way. The reason is that most Americans don’t want to fix the system in that sense. Most are satisfied with their care. Most don’t see (or directly pay) the vast majority of their costs. Because politicians — of both parties — reflect public opinion, they won’t do more than tinker.
As Samuelson points out, this latest round of tinkering won’t work any more than the past 40 years of tinkering has. The problem isn’t that we aren’t doing enough, its that we are asking for the impossible:
Americans generally want their health care system to do three things: (1) provide needed care to all people, regardless of income; (2) maintain our freedom to pick doctors and their freedom to recommend the best care for us; and (3) control costs. The trouble is that these laudable goals aren’t compatible. We can have any two of them, but not all three. Everyone can get care with complete choice — but costs will explode, because patients and doctors have no reason to control them. We can control costs but only by denying care or limiting choices.
Instead of doing that, though, we pretend the contradictions don’t exist by hiding the true costs of the health care system we claim to want. As a result, every “reform” effort has been doomed to failure from the start.
The one thing that has been consistent about the health care debate in this country is that those who advocate greater government involvement, whether it is subsidizing costs by expanding tax deductions as the Bush Administration will apparently be proposing, or out right nationalization of health care, claim that the market has failed and government must step in. As Samuelson points out, this couldn’t be further from the truth:
Now, some say that because the “market” has failed, greater government control is the answer. Private insurance has high overhead costs and generates too much paperwork. True. Still, there’s not much evidence that over long periods government controls health spending any better. From 1970 to 2003, Medicare spending rose an average of 9 percent annually, reports the Kaiser Family Foundation. In the same years, private insurance costs rose 10.1 percent annually. Part of the gap reflected private insurance’s greater generosity. It covered drugs while Medicare didn’t.
As Samuelson says, the only way to deal with the cost of health care is to stop hiding it and force people to deal with it:
Americans want more health care for less money, and when they don’t get it, they indict drug companies, insurers, trial lawyers and bureaucrats. Although these familiar scapegoats may not be blameless, the real problem is us. We demand the impossible. The changes we truly need are political. We need to reconnect people with the public consequences of their private acts. We should curb the subsidization of private insurance. Medicare recipients, especially wealthier ones, should pay more of their bills. But these changes won’t happen because people don’t want to see the costs. We don’t have the health care system we need, but we do have the one we deserve.
More about America’s health care follies at Crazy Politicos Rantings.
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