Friends have been asking lately what I think of the health care bill, now that it has passed (and bears no resemblance to my own health care reform plan). Of course, like the legislators who voted it into law, I have not read the 1000 pages and truly have no idea what the intended and unintended implications might be. But I do get the main point: as a society we will be spending an extra $1 trillion on health care that we wouldn’t have spent previously. This is the part that strikes me as a non sequitur to the debate.
For the past few years we’ve been hearing about how inefficient and ineffective the American health care industry is. We spend ten times as much per capita as Mexico, for example, and achieve a similar life expectancy. We spend two or three times as much per capita as a lot of industrialized nations, are less healthy, and are tortured by paperwork and bureaucracy. If you heard about an industry that was this uncompetitive internationally, the next thing that you’d expect to hear would be “and this is how it is moving offshore” or “and that is why people are choosing to spend less money on this service.”
The logical punchline to the health care discussion should have been “The U.S. health care industry has not been able to deliver most services in an affordable way, so it is going to concentrate on emergency care and simple checkups and screening tests. Ambulatory patients who require surgery will walk into their local airport instead of their local hospital. A Boeing 747 [a product that we are pretty good at making] will take them to a country where they’ve figured out how to take care of people without bankrupting them.”
It is odd that Americans seem intent on believing that we can somehow “fix” our health care industry through clever command-and-control bureaucracy sitting at desks in Washington, D.C., and that this question is worthy of national debate. Imagine if we were buying flat-screen televisions, PCs, and mobile phones made in the U.S. by government and insurance company contractors. An average family’s consumer electronics budget would now be $100,000. Would it be worth debating why these companies needed to charge $100,000 for something that could be purchased from overseas for $2,000? Or would it be more productive simply to import those goods and concentrate on doing other things in the U.S.?
So… for those who have asked. My reaction to the health care bill is bewilderment. We heard all about how much money the U.S. health care industry was wasting. Then our political leaders decided to give the industry an extra $1 trillion. The money is coming from tax increases, so presumably it is being diverted from products and services that American consumers would willingly purchase from efficient and competitive suppliers.
[There does seem to be precedent for this. We heard about how Wall Street and Fannie Mae executives exposed their shareholders to enormous risks so that they could have a chance at earning billions of dollars in bonuses. The industry was fully exposed as a means of transferring shareholder wealth into employee pockets. Plainly shareholders would have been better off investing in German and Chinese financial services firms. The seemingly logical response to the situation would have been to let the insolvent Wall Street banks disappear and be replaced by prudently managed American and foreign banks (this would have required no government intervention). What did Congress and the Federal Reserve Bank do instead? Toss trillions of tax dollars onto the Wall Street bonfire (see my review of It Takes a Pillage).]