Monday, January 12, 2009


Why do Americans have more expensive health care?

Because we order more expensive procedures in a system with few mechanisms to encourage frugality. Our health care system is indicative of our national values, says Bob Samuelson: "highly individualistic, entrepreneurial and suspicious of centralized supervision." Yet, in a system of open-ended insurance reimbursements, doctors and patients alike blow through the most advanced surgeries, diagnostics, and tests.

Samuelson argues that, quite simply, there's "no major constituency for controlling spending." He points out:

Unless we rectify this political imbalance, efforts to control health spending may fail. We need mass constituencies that favor cost control. But our consistent policy has been to conceal the burden of health spending by burying it in untaxed corporate fringe benefits or government budgets.

Abomination that Bush's Medicare Prescription Act was, the singular achievement of the reform was to instate HSA's (Health Savings Accounts).

What better way to enforce frugality that to frame one's medical spending with finite numbers? I know for a fact--and as someone who regularly visited 7 doctors last spring--"drawing down" an account encourages attentiveness to one's medical care, and enforces proactive skepticism. Or, as Samuelson puts it, "[We should] compel Americans to face a discomforting issue -- how important is health care compared with other priorities?"

Given that President-elect Obama is looking to expand government health care, one should ask: Do I really need to pay more taxes for a CAT scan for my swollen toe? Therein lies the problem of universal health care, my friends. Depersonalizing health care provides few incentives to moderate one's spending: why worry, when the cost will be shared by the entire country? (Extrapolate that behavior out, by 300 million. Egad.)

As a result, the burden of frugality is thrust upon bureaucracy. Let's hope Nancy Killefer is darn good at her job.

1 comment:

Les said...

Wow. That's quite a proposition to fix the system. I see where he's going but wonder if that could ever survive the backlash...though I agree it seems like one of the only ways to make genuine progress on slashing healthcare spending. Yikes.