It's easy enough to say that American health care costs more because it costs more. The harder question is why we abide this state of affairs. We have agency. We could direct Medicare to bargain for drugs and devices. We could impose global budgets. We could rate treatments on cost-effectiveness. But we don't. We meekly pay whatever is asked. We demand neither quality nor efficiency nor results. The hypothesis I'm going to offer is not definitive, and is not meant to be. But my read of the evidence is that at the root of our health care problem is an almost pathological aversion to making hard choices -- an aversion that has, in its steadiness and implications, become the most consequential choice of all. At the risk of cannibalizing an upcoming print feature, health care costs are on autopilot. In other areas of life, decisions are made based on whether a particular use of money is a good value as opposed to other uses of that money. Given a budget of $10, a hungry journalist who wants to expense his lunch must choose between the sandwich and the soup. He cannot choose both. The American health care system doesn’t work like that. There is no budget. We don't want one. We’re profoundly uncomfortable saying that a person’s life, or health, is not worth the price of a particular procedure. And so we don't. We are too terrified of waiting for a procedure to even think of not providing it. We ask only that the procedure be proven effective against a placebo. Beyond that, we make no decisions, and we prefer it that way. Better to let five people die passively than kill one consciously. Industry certainly prefers it that way. The consequence of implicitly accepting raging growth is immense spending on health care services. The consequences of immense spending on health care services is tremendous profits for anyone even tangentially related to the medical industry. And they funnel a good chunk of those profits into a fleet of lobbyists and pressure groups who work very hard to dissuade the political system from approaching the cost question. A good example of this came during the stimulus debate when the pharmaceutical and medical device companies launched a shock-and-awe lobbying campaign against a misread sentence in the comparative effectiveness provisions. The misreading? That the provision would allow the government to use the evidence from the studies to make coverage decisions. The misreading, in other words, was that the policy was more rational than it actually was. But don't blame our legislators: They face, on the one hand, the public's fear of rationing, and on the other, the united opposition of some of the most moneyed industries in the country. There is no constituency for real reform. We're abetted in this radical effort to avoid responsibility by the hide-the-sausage nature of the health care system, where somebody else pays for most everything. We never see the real cost of medical care because it's paid for by insurers. We never see the real cost of insurance because it's paid for by employers or tax dollars. We never see the real cost to employers because it disappears from raises we never realize we would have otherwise gotten. We never see the real cost to government because so much of the money is borrowed. But there is a cost -- both economic and human. For that, however, I'm going to have to defer to the June issue of The American Prospect, on newsstands (sort of) soon! Related: Why American Health Care Costs So Much (Part One).
