Thursday, May 08, 2008


One of the reasons that healthcare in the United States is so expensive is that a significant portion of healthcare expenditures is, in effect, a tax we pay pay to maintain certain illusions. We willingly pay millions of dollars to maintain the illusion that nonagenarians who have suffered massive strokes might somehow completely recover. We pay to sustain the illusion that our healthcare policy is concerned primarily with what is best for the patient. We fund the illusions that self-destructive behaviors are just bad luck, that all people access the system only for health-realted reasons, rather than a small portion who do so for secondary gains. We pay to accommodate the fashions that various forms of quackery are therapeutic, that the natural course of many objectively terminal diseases is cure rather than death, and that a hospital that looks like a hotel is somehow better than one that does not. One of the reasons that the American healthcare system is so expensive is that there is little seriousness about making it otherwise, because we like our illusions and are willing to have "the system" pay for them.

There is a contradiction regarding the quality of the American healthcare system, in that it is sometimes described as the best in the world and othertimes derided as being the most expensive but inferior to most of the developed world. The resolution of this anomaly lies in acknowledging that both views are correct. The fact is that the American healthcare system is designed to achieve different goals than those of other countries. If the goal of the U. S. system is limited to providing universal preventive care, it could probably do that quite efficiently. If its focus is limited to provide a catastrophic safety net it could probably do that as well. But the American healthcare system is intended to fulfill many roles, which have the effect of benefitting the rest of the world. The American system advances the state of the art, and is to a large degree resonsible for much of the progress of the art of medicine worldwide. The American system encourages access to technologies that are not always economically beneficial (there are probably way more CT scans performed here than need to be) but which may make the underlying technologies more economically available in the future. In addition, there is a large sociological component to the delivery of healthcare that would go unnoticed if the goal were simply to queue people up to receive their alloted share of services. Part of this is because American society is more diverse than say, Japan or Cuba. We have expenditures for artificial joints in octogenarians, which would be unlikely to be priorities in a more "efficient" system.

There are many ways that the American healthcare system can be improved, but first we have to realize that not all of the problems are due to greed or the bad character of "them." A lot of it is due to choices that we make, and interests that we protect.

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