Expenses in health care

When healthcare policy makers contemplate what makes healthcare expensive, they may do well to ask a related but less obvious question: what makes healthcare policy so expensive? A healthcare system of course pays both for healthcare and the added policy costs. In assessing the costs of healthcare policy, a few simple observations come readily to mind:

1.) Ideology is expensive. Certain types of reformers think that the healthcare system must not only address the provision of healthcare services, it must also "send a message" or provide symbolic declaration of some cultural value or other. These ideological accessories cost money.

2.) Unrealistic expectations are expensive. It is a fallacy that a possible outcome is achievable, no matter how unlikely, if only sufficient resources are spent to attain them. Policies that view particular outcomes from the perspective of entitlements perpetuate this fallacy, and it wastes a lot of money.

3.) Sentiment is expensive. When outcomes are assessed against their ability to cause emotional distress, rather than the practical likelihood of achieving them, expenditure decisions become emotional, irrational, and profligate.

4.) Corruption is expensive. The vast amounts of money spent on healthcare engender innumerable opportunities for fraud, misuse, rent-seeking and graft. This only seems to become apparent after the fact, despite the fact that it is inherent in human nature.

5.) Ignorance is expensive. Is it more expensive for an airline to have its aircraft engines maintained by trained mechanics or by people who have a few ideas about how they think the engines should operate? The difficulty with healthcare policy is there is practically no one with the depth and breadth of knowledge to maintain and design global improvement for such a complex, intricate, and expansive system, yet this seems to be no impediment to policy makers who are self-sure that they know the one or two things to change to produce a system that is fair, inexpensive, innovative, high quality, accessible, compassionate, etc, etc.