The Real Cause of Health Care Dysfunction
It's Us
With “our health care system” in the news recently, you are invited to revisit my essay Crisis of Abundance, which in turn reprises my 2006 book. An excerpt:
The conventional wisdom is that our health care is too expensive, as if somebody in the supply side (insurance companies, doctors, pharmaceutical companies) is ripping us off. According to this view, if government negotiated lower prices, we could obtain even more medical services. When I looked at the data when I was doing the research in my book, I did not find much support for this conventional narrative.
The reason that we spend so much on health care is that we obtain a lot of procedures that have high costs and low benefits.
When I wrote my book, the United States was spending a larger share of our GDP on Medicare than other countries spent on health care for the entire populations. So anyone who thinks that making more people eligible for Medicare would solve our over-spending problem is delusional.
The over-spenders are us. We go for too many expensive tests that rarely make a difference to our lives. We get surgeries and take drugs for ailments that people used to just live with.
People would much rather hear that they are being ripped off by doctors, hospitals, and insurance companies. Of course that sometimes happens, but it is not the main driver of our high rate of spending.
"The over-spenders are us. We go for too many expensive tests that rarely make a difference to our lives. We get surgeries and take drugs for ailments that people used to just live with."
I think this is 100% true, but (and maybe I'm reading too much moralizing into your statement) I am not sure that we can "blame" them. We-the-patients indeed are over-spending, but it is because we actually cannot ascertain "expensive" or "makes a difference" or "how to ameliorate our ailments."
If a child goes to a candy store with no listed prices, and his parents tell him "we will buy you anything you want" and "did you know that gold-leaf macarons are very healthy?" and he snatches up a thousand dollars of treats, it is .... true... that he is the over-spender, and that his actions were the cause of the massive bill. But if we are trying to FIX the problem, we need to look at the system his parents created.
I am a physician. Been one since 1979. The system rewards procedures and is financed by healthcare being delivered in “units” rather than outcomes. The HMO system with primary care gatekeepers was introduced to fix this and was crushed in the 1970’s by insurance companies, healthcare systems where administrators are paid exorbitant sums of money and are allowed to spend money on things like DEI initiatives rather than health care, and lobbyists and medical specialists who benefit from those procedures rather than delivering “health.”