Pessimist, me? No more than I am pessimistic about the chances of the Mississippi starting to run north from the delta to Minnesota. Just aware of the realities.
Fact is, that there are three things which combine to head our current American health care system over the cliff, soon to be replaced by some other system.
First, everyone agrees that health care is horribly expensive and getting more so. It now consumes one-sixth of the American economy. The one thing everyone seems to agree on is that this trend cannot continue. But costs cannot be lowered to any great extent because the consumers of health care do not know what health care costs and they don’t care. When is the last time you shopped for a doctor based on price? Who is the last person who told you he changed from Dr Bob to Dr Tom because Dr Tom charges $15 less for an office visit? And why not? Because someone else pays the actual bill. We care about our deductible and our co-pay, neither of which has anything to do with actual costs of care. When there is no consumer pressure on prices, prices go up. That’s Economics 101. There is no theoretical ceiling to this phenomenon. We do complain about our insurance premiums going up, but that is a symptom, not the cause.
Twenty-plus years ago, my young daughter fell while playing and cracked a bone in her elbow. Her doctor gave us the following scenario: “Well, current wisdom is to hospitalize her, do surgery to install a screw in the bone to secure it, cast it, and bring her in for x-rays every couple of weeks for a couple of months. Then, we put her in physical therapy to recover the function lost in treatment. But a few years ago, we would just splint it, wait two weeks to see how it’s healing, do one x-ray, let her get a little physical therapy, then let her finish the process by using that elbow for a little longer every day outside the splint.”
Since we had no insurance and actually paid the bill ourselves, this was a helpful revelation. We took the “old way” and that little girl healed just fine. At about one-tenth the cost. When’s the last time you had this kind of discussion with your pediatrician?
Second, we have recently developed a very entitled view about our health. Grandad’s generation accepted aches and pains as part of life, and more so as a part of old age. Not us, boy. If it hurts, or even annoys us, we beat it to the physician for treatment and whip out our insurance card. Acne gets prescription meds and dermatologists are among the best paid of all physicians. Male pattern baldness is now considered a treatable disease, not just a fact of life, and billions-with-a-B have been spent on prescription Rogaine. If Granny’s 80 year old knee gets stiff and painful, she gets not pain meds but a new titanium/nylon knee replacement for a mere $25,000 from taxpayers. When wanting a longer-lasting erection entitles any man to medical intervention, we have passed the point of no return and reason has left the building.
Third, we have decided that end-of-life is also a treatable disorder. The majority of medical care expenditures are incurred by the elderly, and much of this is life-sustaining care.
I don’t mean to sound hard-hearted. Nobody wants his loved one to suffer, but when the choice used to be bankrupting the next generation or suffering personal pain, most of our recent ancestors would have found the choice easy.
Note that none of these problems have to do with government policy. It’s not the problem, so it can’t be the solution.