I’ve been asked to give my ideas on what real health care reform would look like and I’m a bit nonplussed. Here are a few facts about our present health care system:
- We spend more on health care per capita than any other OECD country by a substantial margin.
- Other OECD countries adopted their own systems when health care was much, much less expensive than it is now.
- Health care presently comprises about 17% of the U. S. economy, more than any other OECD country, and prices in health care are growing at a multiple of the prices in most other sectors with the exception of education which has much the same problems as the health care system.
- Government at one level or another provides between 50% and 70% of all of the funds spent on health care.
- The incentives for government to increase health care spending have outweighed its incentives to restrain spending to date.
- Prices in other sectors of the economy have been kept low through mass production.
- In health care we have mass consumption and artisanal production—an obvious mismatch.
- Physicians produce much of the demand for health care.
- We haven’t had a free market in health care for more than a century. I don’t believe we want one.
- Health care insurance prices are proportion to health care prices.
- The evidence that increasing health care insurance coverage in the absence of a commitment to control costs will reduce costs is weak.
- At present prices and the present rate of increase a single-payer system will solve nothing.
Somewhere in all of that there may be a solution but I’m damned if I see it. At least not a solution that we want.