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John Derbyshire believes health care costs a lot because people expect to live longer:
[I] simply can't understand why people want to live into their eighties. ... You run around for a few years having as much fun as your circumstances allow. Then you get married and have kids. You give the kids as much as you can to get them started in life. After that you're pretty superfluous; and, as VDH says, you start paying for the follies of youth. After about sixty it's pretty much diminishing returns, far as I can see.Right now I'm imagining the 1940s equivalent of Derbyshire commenting on the mass production of penicillin: 'I don't understand why people want to want to live into their sixties. You run around for a few years, you get married and have kids, and then once you get a bacterial infection, you die. After about 40 it's diminishing returns, as far as I can see.' Apparently the 'standing athwart X, shouting stop' formulation works for life expectancy as well. Policy-wise, Derbyshire and his referent, Victor David Hanson, are arguing that health care is now so expensive because people want to live longer, healthier lives, and that this goal is somehow inappropriate compared to the "ancient tragic view" that we should die, well, life expectancy has been rising for some time now but I suppose Derbyshire and Hanson each have some ancient life expectancy that is appropriate. I, for one, look forward to a health care debate where the conservatives argue that people should just die sooner (it would probably solve that pesky social security problem as well) while liberals argue that cost-effective health care reform will improve both public health and the government's long-term fiscal health.But in any case, Hanson's argument is more or less dispelled by noting that health care reformers want to focus on preventative care so that some of the problems he thinks are inappropriate (paying for the future health care costs of people who were reckless with their health) dissipate. But the real reasons that health care is so expensive is that we overpay -- we overpay for administration costs, for drug costs, for insurance costs, for unncessary procedures, to the tune of hundreds of billions of dollars. And all that for outcomes that aren't as good as countries paying considerably less. So on one hand, we could examine that system and improve it, or we could simply halt the historic increase of life expectancy in order to have people die when they are younger. Derbyshire acknowledges that this is something of a personal opinion -- who hasn't thought with dismay about the indignities of aging -- but he's deploying it in service of an argument about public health policy. Ideas have consequences. That's one of yours, right?
-- Tim Fernholz
