Saturday, June 2, 2007

Why health care is so costly: we have only ourselves to blame

If I buy an auto or a suit without regard to cost, I shall have a problem. Not so with health care. Nobody is minding the cost of the biggest blunder of modern society. Bleeding heart approaches to health care have created an elephant in the room that nobody sees. In order to assure that most people avoid ever being desperate for badly needy medical care, we have created a medical care engine that grinds out vast processes of medical testing, questionable and expensive procedures, enormous drug consumption and physician-directed, needless steps in care including follow-up office visits. There is no control of this wild consumption of our taxes through Medicare and Medical or even private insurance fees. Nobody is minding the store, of course.

There is an answer. In most economic areas we have found the answer: it is the method by which most people drive cars and live in homes that are in line with their income. In medical care, because of possible pain and of potentially festering maladies, all stops are out to prevent anybody from being shortchanged on care, and because no thought is given toward nudging people to spend in proportion to their ability, the cost of medical care has become an outrageous burden on government budgets.

People go to the doctor for trivial matters. Doctors run too many tests and arrange too many return visits. Hospital stays are cautiously lengthened. The cost of care for dying people is unbelievable. People usually never challenge a doctor's unneeded extra care because it is essentially without significant cost to them. There is very little subtle regulation of medical costs, so, of course they are out of control. On the other hand, in the rest of the money exchange world when people must pay in proportion to their ability (or go bankrupt) to drive expensive new cars, take fancy vacations and wear fancy clothes, the world of commerce and consumption works automatically.

Private and government health insurance should cost a person in proportion to his ability to pay – say, in proportion to one's income tax bill. This would raise the obvious cost of medical care for a large portion of the public and hence make them more conservative. Currently, they don't even think of it as having a cost/benefit aspect. This would change the whole nature of doctor-patient workings that currently lead to unnecessary, costly care and procedures that are covered by fiat rather than the willingness of the patient to consider the cost of a specific care.

Can one imagine anybody voting for a representative who would advocate this approach. No, the public would rather take from Peter to pay Paul and from, only seemingly, anybody but themselves.

We cannot blame the doctors for advocating extra care. That's their business: caring more and making more money. But don't try blaming the voters. We don't even know who they are.

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