The Bottom Line

I have yet to hear an adequate explanation of why health care costs keep rising so fast. Reasons abound: the aging population, the fact that we’re all too fat and sedentary, the extraordinary increase in expensive medical technology of late, the need for insurance companies to make up for stock market losses . . . . All of them probably contribute: a problem this big is bound to be complex. Some of them we can’t do much about: people get old, and trying to get Americans to change their lifestyles is a bit like herding cats, except that cats are trainable.

But the last two seem to me to be something we can actually fix–or if not fix, at least ameliorate. They arise, as no one wants to admit because it’s blasphemous in America to do so, from a failure of the free market system. The fact that we even allow something as important as health insurance to be subject to the vagaries of the market seems a little short-sighted and foolish. But, of course, that’s the real way these companies make their profits–and if that doesn’t work, they have to raise your premiums, and if that prices you out of the market, too damn bad. Insurance comapnies are in business to make money, and if your own health is deleterious to the bottom line, guess what? You get the boot.

The seeming need for the hottest and greatest medical gadgets comes from a similar problem. In order for health care providers to compete with one another, they must be able to call upon all those great technologies. You wouldn’t go to a doctor who didn’t have his own combined MRI, laproscope, laser-surgery suite, would you? The problem is that if one guy in town has it, everybody has to have it to keep up. And, again, there’s no way they’re going to just eat the expense: they’re going to pass the costs along to you–and, if you use insurance to pay for your health care, to everyone else too in the form of, yet again, higher premiums. We see similar problems in cable, long-distance, even local telephone services now. Remember when politicians were telling us deregulation would lead to lower prices? If technological infrastructure is involved, you can forget it.

This is where government health plans help: if you only really need one MRI for every 5,000 people, that’s all you’ll get. But this is America, and that ain’t gonna happen.

So what do we do? We can fix health care on the insurance side, at least for a few people–those priced out of the market, specifically–by doing something very simple in concept (though perhaps administratively complex): provide the same coverage offered under the pre-existing Medicare or Medicaid packages as cut-rate no-frills insurance on a sliding-scale based on ability to pay. This would cover the working poor, those in entry-level or part-time jobs (who are very often young and healthy) which rarely offer insurance, or anyone else who wanted to contribute. It would not be free, but it would help subsidize the existing free plans and would allow many to get some kind of insurance who otherwise wouldn’t. It would not solve all of the free-market problems with health care, but it would also be less subject to fluctuations in the Dow. Being a government agency, it would not need to turn a profit, but if it did, that money could be used to lower taxes on everybody else who now pay for Medicare and Medicaid–and that’s something just about all Americans agree is a good thing.