US/healthcare/costs

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About

Healthcare costs have become a major problem in the United States. Many possible solutions have been advanced, but very little progress has been made towards settling on any given solution, and the problem continues to get worse.

Framing

The problem is often politically framed as a choice between a "nanny state", i.e. a single-payer system operated essentially by the government – an idea generally loathed by conservatives, or the more "free enterprise" system which we supposedly have now. This is actually a false dilemma, as pointed out in the following comment:

Catfish N. Cod said, on 2008-02-15:

Health care costs in the US are absolutely insane, it's true. But it's not a MARKET that leads to insanely high prices. If we actually had a health care MARKET then supply and demand would drive costs down -- especially with the massive influx of doctors and nurses from everywhere on Earth that want to take advantage of high US health care spending.

But the health care MARKET mostly doesn't exist. When was the last time you found out what anything about your health care cost -- BEFORE you received the product? How about a posting of what the competition was charging? An estimate of the insurance company's share?

Having a MARKET -- one of Dr. Brin's "accountability fora" -- requires some basic elements, including:

  1. Fungibility of product -- it really doesn't matter who you buy from
  2. Posted prices -- no pigs in pokes
  3. Verifiability data -- no wool wrapped in silk
  4. Ease of choice -- a cheap alternative does no good if it's up a dirt road in Tibet

If we had these things in health care, we could have a MARKET that would drive prices down. But that's the LAST thing we have today. Instead we have:

  1. Feudal and monopolistic organization of health care that makes choosing out-of-network doctors difficult and expensive
  2. Complete obscurity of price -- I'm in med school and I can't figure out my own med bills
  3. Poor data collection, poor analysis, and a lot of covering-up in med quality data -- driven in large part by fear of lawsuits
  4. Lack of choice -- often a single organization controls all the hospitals in a region

Now, with some transparency regulation, portions of the medical system could become a MARKET, causing price wars to eliminate the exorbitant charges. The problem with a single-payer system is that, by itself, single-payer grants no transparency. I don't trust bureaucrats to negotiate behind closed doors in my name, and I don't care if they are public or private bureaucrats. I want to be able to see the cost savings, dang nabbit. Transparency forever!

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The Rockridge Institute said:

The next instance of a conservative frame in a question was by co-host Scott Spradling:

SPRADLING: Thanks, Wolf. Senator Edwards, question for you, sir. I was struck by your conversation that you had a moment ago about dishonesty in politics, and wanting to make things clear. This is a health care question for you, and really focusing on price tags here. Governor Richardson, for example, says that you can fund health care meaningfully without raising taxes. Senator Clinton has said that she's not prepared to say she will raises taxes to reform health care. Your plan does raise some taxes to fund your universal health care program. So I am wondering: From your perspective, are they being honest about the true costs of universal health care in America?

This question was framed as if the "true costs" of health care mean only taxes! As Spradling hinted, the implementation of universal health care will require taxes to be raised. Operating within the conservative worldview, Spradling implied that taxes are always bad. Rockridge has previously discussed the conservative view of taxes. In the conservative worldview, taxes are interpreted as a burden that the government must lighten (as opposed to the progressive view that taxes contribute to infrastructure, protection, and citizen empowerment). In any direct "answer" to the question, the conservative framing is accepted.

The question also suggested that taxes are the only "costs" of a national health care system, effectively ignoring the progressive notion that there are similar costs to society for not implementing universal health care. There are costs to the labor market, costs to doctors and nurses, costs to rural communities, and human costs. The U.S. has the highest infant mortality rate in the developed world due to our lack of pre and post-natal care. We rank 33rd in life expectancy for males and 32nd in life expectancy for females. These statistics should have been presented as the "costs" of not implementing a wide-reaching health care policy for U.S. citizens.

And none of this even gets to the oft-cited fact that federal taxes don't pay for government operations but are all used to service the national debt...

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