Wednesday, January 25, 2006
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.
Disliking the inconsistencies, we hide them -- to individuals. We subsidize employer-paid health insurance by excluding it from income taxes (the 2006 cost to government: an estimated $126 billion). Most workers don't see the full costs of their health care. Nor do Medicare recipients, whose costs are paid mainly by other people's payroll taxes.
We're living in a fantasy world. Given our inconsistent expectations, no health-care system -- not one completely run by government or one following ``market'' principles -- can satisfy public opinion. Politicians and pundits can score cheap points by emphasizing one goal or another (insure the uninsured, cover drugs for Medicare recipients, expand ``choice'') without facing the harder job: finding a better balance among competing goals.
....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 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.
Read the whole thing, as they say.
posted by Sydney on 1/25/2006 12:39:00 PM 3 comments
Uwe Reinhardt used to say some of these same things, back in the 1980's. Then he stopped.
By 2:42 PM, at
For once someone is honest about what we have...
Hi. I was out blogging and hit yours. You seem to have a good blog here. Good job, happy blogging.