Health Insurance
Arnold Kling as a good TCS article up called, Who Wants Health Insurance?
On the Left, the arguments runs: Europeans have lower per capita spending on health care than Americans. Europeans have much more of their health care paid for by government than Americans. Therefore, we could lower our spending on health care by switching to single-payer health insurance. However that is like saying that because a fruit cup topped with powdered sugar has lower calories than double-fudge chocolate cake topped with icing, that we could have a low-caloried dessert by replacing the icing on the cake with powdered sugar.
Lots of interesting stuff, although I am not sure I agree with all of it.
I have a worm’s eye view of this, being a super-specialized M.D. (an otologist-neurotologist. that’s so subspecialized I bet you haven’t even heard of us.)
Here’s the short version: excellent health care COSTS MONEY. Examples abound: there are only a handful of people who exclusively do otology/neurotology in Europe, and they tend to be chairmen of large academic departments, so you have essentially no access to them. Far more likely for the average patient to get a novice or a dilettante as their surgeon. So access to expertise is rationed.
Another case in point: I was speaking to a mid-level prof at U of Tuebingen and he told me that his entire facility gets a maximum of 10 cochlear implant devices per year, for a population that would best be served by having 40 to 60 of these procedures per year. So access to medical devices is rationed.
Can we become more efficient as healthcare providers? Absolutely, but most hospitals, which generate the majority of healthcare-related charges already have an incentive to do so: it’s called the profit motive. State slush funds typically keep hospitals afloat if they have a high percentage of indigent patients, but unprofitable hospitals can and do go out of business. Unfortunately, I think we can only lower costs by decreasing access or decreasing quality. I don’t even think castrating the plaintiff’s bar will make much of a difference.