While I agree with the gist of what Megan McArdle has to say in her recent piece about reforming the U. S. health care system at Bloomberg View:
Why are memes like this so compelling? Because they’re easy. But the whole truth is not so easy. And solutions for Americans’ health-care complaints? Those are really hard.
which is that reforming our system is hard, I’m not completely in agreement with her about everything. There are many complications including:
- Insurance is not care.
- Care is not health.
- Health is dependent both on factors that can be affected by changes in care or government policy and factors that can’t, e.g. genetics, individual personal behavior, or at least can’t without grave difficulty.
One of the dirty little secrets about health care is that spending is lower and health is better in some OECD countries in which the people, for various cultural reasons, don’t seek as much care as Americans tend to, e.g. Japan. Praise is often lavished on Singapore’s system. If Americans sought as little care as Singaporans do, our system would be less expensive, too. And, shazam!, places in the United States that are more like Singapore than they are like, say, Indiana, e.g. Hawaii, also spend less on health care.
And then there’s the most serious complication: one person’s spending is another person’s income.
Praise is selectively lavished upon the Singapore system. It has some market mechanisms, but it also has price controls and the government actually runs some of the hospitals. Suspect it helps when you don’t have to figure out how to provide care to rural areas.
Steve