HEALTH REFORM FOLLIES

Paul Krugman believes some version of health reform will pass, and it will prove popular with the people, just as (he believes) it is popular in Massachusetts.

Robert J. Samuelson has it right when he points out, as he has in the past, that the debate we are having about health reform is phony, since we refuse to honestly talk about why costs are going up, and why a public option (or any other reform being discussed) won't solve that problem.

In the end, I believe, no matter what passes Congress (and I am still skeptical about them getting something done), costs will continue to rise at an unsustainable rate. Why? Because, since health care is a service provided by people to other people for a fee, and because the people receiving the service are still mostly insulated from the true cost of the service they are receiving, and because the people receiving the service do not have the ability or the inclination to shop around among those who are providing that service, and because technological advances continue to provide more equipment, drugs and services (all of which cost money), and because our population of elderly people who require more services continues to grow, than it stands to reason that costs will continue to go up.

There are only two ways that I can see to restrain costs. One is to restore a true free market system where people purchase health services directly. Since most people would be unable to afford most services at their current prices, they would not use the services, which would force the providers to lower their prices or find another line of work (this would also be true if we maintained a system of health insurance, as people could only buy what they could afford, forcing prices down). We will not adopt this system, because it would leave many millions of people without health care, except by going to emergency rooms or charity wards.

The second way is to have the government provide health care directly, via a national health service as they do in Britain, or via a government-run and financed health insurance plan, as they do in Canada. With only one entity paying the bills, and that entity having the power of the state to enforce compliance, the providers of the service would be limited as to what they can charge for such services, thus forcing prices down. We will not adopt this system, because many health care providers will simply leave the system, thus causing shortages, and patients will find all sorts of drugs and procedures unavailable to them because such shortages, and the rationing that will inevitable ensue.

So, what will we do? Facing the problem of rising costs, our political leaders will pass some mish-mash of a bill that seems to help, but won't. After a few years it will become apparent that it didn't work, so another set of 'reforms' will pass, which will also be a mish-mash. When we are approaching true bankruptcy as a nation, some radical plan will finally be passed (and I haven't a clue which way it will go, that will depend on the overall political climate at that time).

It's not a pleasant vision, but that is how I see it.