Observations on the Health Care Market, on the Eve of its Destruction

Observation one:  health care is not a market.

This should be entirely obvious, but it seems to escape a surprising number of commentators:  nobody actually shops around for cheaper health care. When you have a heart attack, you do not compare prices at a range of hospitals before getting into the ambulance.

Observation two:  we are not the sort of people who allow the poor to die in the streets.

This observation is probably more aspiration, if I’m being completely honest.

Corollary to observations one and two:  reducing health care costs can only be accomplished by improving the efficiency of delivery.

In other words, forcing poor people to get their care in emergency rooms, which are by far the least cost-efficient place to take care of almost any medical problem, is not a good strategy for reducing health care costs.

Corollary to the above corollary:  taking insurance away from twenty-six million people will unquestionably drive overall health care expenditures up substantially.

Who will pay these extra costs?  Well, here is a partial list of people and organizations who will not:

Insurance companies—they will raise premiums to match expenditures.

The people who are having their insurance taken away—as is often said, you can’t get blood from a stone.

The wealthy—they now have complete control over the federal government, and will undoubtedly defend their interests vigorously.

Who is not on this list? This is left as an exercise for the reader.

Observation three:  if you believe that your exercise and vitamin regimen mean that you will never need medical care, you are an idiot.

Another point which seems very obvious, but apparently is not.

Observation four:  if you believe that because you are young and healthy now, you will always be so, you are even more of an idiot than those addressed in Observation three.

It saddens me that this one even bears mention.

Observation five:  The United States is the only developed nation on the planet that seems not to understand the points listed above.

The implications of this point are also, depressingly, left as an exercise for the reader.