At The Daily Beast Matt Lewis considers the history of the U. S. health care system:
During World War II, government intervention in wage controls had unintended consequences that are still being felt today. Businesses couldn’t woo top talent by offering them more money, so they instead sweetened job offers by adding fringe benefits, including health care. The result was a Catch-22: Because health insurance was paid for by a third party (your employer) instead of the beneficiary (you), there was no incentive to keep costs low. As a result, almost everybody had to be an employee—because health care costs were too high to pay for out-of-pocket.
We’re still living with the consequences today. As Sen. Rand Paul recently observed, “The reason capitalism doesn’t work in health care is the consumer is disconnected from the product… When you connect with the consumer, and the consumer cares about the price, guess what? The consumer will shop. And when the consumer shops, competition works. But we’re not really doing that in health care.â€
And as Jeff Jacoby noted years ago, “Why is it that in every other field where enormous technological strides have been made, total costs have fallen over time, but in health care they have increased? The answer is simple: Health care costs so much because most of us pay so little for it. And we pay so little—out-of-pocket expenses amount to just 14 cents of every health dollar spent in this country—because a third party nearly always picks up the tab. For most working Americans, that third party is an insurance company paid by their employers.â€
I think he’s overlooking something. If weavers had the kind of control over how weaving would be done in the 18th and 19th century that physicians have over how medical services are provided, none of us could afford to buy underwear. Employers are only part of the problem. A much larger component of the problem is that who should provide medical services, what services should be provided, when they should be provided, and at what cost is determined by those getting paid for the services.
I do agree with his conclusion. When the United Kingdom was adopting its National Health Service we were consigning the health care of American workers to their employers. Now health care is shared among employers, the federal government, and state governments. There are so many interests at stake it will be impossible to untangle them.
There’s an old joke about traveling in Maine. After wandering for hours along rural roads, some travelers stopped at a general store and asked those sitting on the porch for directions. After thinking for a while the Mainesters replied “You cahn’t get they-ah from he-ah.” That’s how it is with affordable, effective health care in the United States. We can’t get there from here.
The questions that should be asked are
- Does the proposed reform move us in the direction of a more affordable, more effective, and more just system?
- Does the proposal stand on its own? Or will it require frequent adjustment? Our history tells us we don’t have the appetite for that.
- Over what time frame do you anticipate the process of change to take place?
Those are the questions that should have been asked but weren’t in the mad dash to enact the Affordable Care Act in the first place and those are the questions that should be asked about the attempt to “repeal and replace” it.
