My editor Bob Kuttner has a terrific commentary in the most recent New England Journal of Medicine on how the profit motive foils cost control in health care. Think of it this way: It's perfectly normal for a profit-maximizing business to try and increase volume of sales. No one minds that Best Buy tries to sell a lot of televisions. But the same thing goes on in health care. In electronics, however, there's an easy check: We feel perfectly comfortable telling the Best Buy salesmen "no," or not stepping into an electronics store at all. When we come into contact with the health system, however, and the doctor writes down our prescription, we just about never feel comfortable saying no. And while doctors aren't pure salesmen by any means, they do work in an industry where the incentives, both monetary and professional, are towards increasing volume of treatment. Doctors are not rewarded -- by anyone, including patients -- when they tell you to do nothing. So as long as we put them in a system when the pressures are all towards doing more, they will indeed do more, and we will accept it, and costs will continue to march upwards. Ending that cycle will take more than mere national health insurance, it will require national health insurance coupled with a very different attitude towards health care.
