To extend [health care] coverage without changing these [cost-inflating] dynamics would add on another $77 billion of spending beyond what it should cost.
That is Ezra Klein, his post has some interesting data. Note that while we might shift some of the financial burden of pharmaceuticals to Europe and elsewhere, this hardly qualifies as a global welfare improvement. There are plenty of other ways to redistribute money from foreigners. I am, however, struck by this bit:
Another $147 billion in increased spending, much of it a consequence of
the fee-for-service system, wherein doctors are paid based on how many
procedures they recommend and carry out. Doctors with equity in
facilities where they can co-refer cases conduct between two and eight
times more tests than those without equity interests.
Some of this is third-party payment, but more generally the consumer as monitor is often either insane or asleep. To get what is really wrong with health care markets, we must turn to the academics, not as analysts but rather as examples:
One 47-year-old professor, a classic blunter who had received a
diagnosis of prostate cancer, told me: "I would be insulted if some guy
read 15 papers on theoretical physics, my own field, and then came in
and asked me to help him design an experiment. And I expect the same of
my doctor. I pay her. Let her sit down and tell me exactly what I need
to know — what are my choices and what do they mean? That’s her job. I
have other things to do."
Many consumers just don’t want to face the stark realities of how they are doing. How about letting me make the health care decisions for a randomly chosen partner, and vice versa? Here is much more, via Craig Newmark. On related topics, here is Arnold Kling.