Jeff Jacoby has an editorial today arguing that we should delink health care from employment, which I agree with, and asserting that the problem in health care is consumer overconsumption, which I don't really agree with, because it distorts who really exercises the decisive influence over health care spending. But Jacoby's analysis is a common one: Because health insurance is routed through our employer and the bulk of the costs are paid before we ever see them, we "ended up with a healthcare system in which the vast majority of bills are covered by a third party. With someone else picking up the tab, Americans got used to consuming medical care without regard to price or value."This sentiment is widely shared, and very weird. Think of how an individual consumption decision traditionally works. You, the consumer, decide you need a desk lamp. You make a decision about where to purchase a desk lamp. You transport yourself to the Desk Lamp Emporium and compare different desk lamps. They're too expensive, or too ugly, and you have overhead lighting anyway. You don't buy a desk lamp. Maybe you'll purchase one later. Now think of how an individual consumption decision in health care works. You, the consumer, go for an annual check-up. You feel fine. Your doctor says that you exhibit various risk factors for heart disease, and he'd like to schedule something called a "coronary angiography." He'd like to do this because it's possible that doing it will keep you from dying. You say okay. You endure the invasive and unpleasant and expensive test, because you don't want to die. The results return, and are explained to you by a cardiologist. He recommends double-bypass surgery. Otherwise, he says, you might die. You don't want your sternum cracked open and a surgeon's hands deep in your chest, but you accept the diagnosis because you really don't want to die. WHO'S THE DECIDER?
Jeff Jacoby has an editorial today arguing that we should delink health care from employment, which I agree with, and asserting that the problem in health care is consumer overconsumption, which I don't really agree with, because it distorts who really exercises the decisive influence over health care spending. But Jacoby's analysis is a common one: Because health insurance is routed through our employer and the bulk of the costs are paid before we ever see them, we "ended up with a healthcare system in which the vast majority of bills are covered by a third party. With someone else picking up the tab, Americans got used to consuming medical care without regard to price or value."This sentiment is widely shared, and very weird. Think of how an individual consumption decision traditionally works. You, the consumer, decide you need a desk lamp. You make a decision about where to purchase a desk lamp. You transport yourself to the Desk Lamp Emporium and compare different desk lamps. They're too expensive, or too ugly, and you have overhead lighting anyway. You don't buy a desk lamp. Maybe you'll purchase one later. Now think of how an individual consumption decision in health care works. You, the consumer, go for an annual check-up. You feel fine. Your doctor says that you exhibit various risk factors for heart disease, and he'd like to schedule something called a "coronary angiography." He'd like to do this because it's possible that doing it will keep you from dying. You say okay. You endure the invasive and unpleasant and expensive test, because you don't want to die. The results return, and are explained to you by a cardiologist. He recommends double-bypass surgery. Otherwise, he says, you might die. You don't want your sternum cracked open and a surgeon's hands deep in your chest, but you accept the diagnosis because you really don't want to die. 
