While I'm on a roll, commenting on everything Pythagosaurus posts (I'll get my own brain soon, I promise) I thought I'd throw in my thoughts on the whole health care thingy:
The interesting thing about the prescription drug benefit is that it was intended as leverage to get certain elements of Congress to agree to reform Medicare. There is a certain crunchy political compromise sort of goodness to that - in exchange for enacting a hideously expensive piece of crap legislation, we will excise the worst parts of a grotesquely expensive, double-plus crappy abomination of a legislation. Instead, we now have both, which is more stupendously expensive crappiness than you can shake a stick at, plus the stick.
The prescription drug benefit program's only saving grace is that it might not kill the goose that lays the wonderful, groovy new drugs. In every other way, it is an immoral, bald faced, long term mandate for thievery from the younger generations. But the drug benefits are really a side show in the larger catastrophe.
There are three elements that form the center of my perception of the problem:
- The health "industry" constitutes as much as a seventh of the total US economy.
- Old people represent a growing percentage of the whole population. Not as bad as Europe or Japan, but still
- The Byzantine and corrupt nature of the industry as a whole compromises the effectiveness of the system.
Starting from the bottom, why does it cost $12,000 to get your arm repaired after your neighbor jumps up and down on it? Assuming that your mom drives you to the hospital, what kind of costs are we talking about? A few minutes for the receptionist. A half hour each for a nurse and a doctor, fifteen minutes for the radiologist and the cost of running the x-ray machine, the broken bone kit in the nifty sterile packaging, some overhead costs to keep the nice hospital open, and some powerful narcotics to dull the existential angst of realizing what a dumbass you were to let your neighbor jump on your arm.
I added that up, and came up with about $500. And that was assuming that doctors were charging $300/ hour for their time, and nurses half that. Even assuming that my perception of the costs was off by an order of magnitude, that still leaves you $7,000 short of $12,000. Where does the extra money come from?
Malpractice insurance to protect doctors from the ridiculous lawsuits we as a people are prone to. Also, extra tests as an added safeguard from lawsuits. The bloat of the insurance industries, which encourages doctors to overcharge. And the labyrinthine regulatory hairball that surrounds the entire industry.
I have no problem with doctors making money. They studied far harder and longer than I ever did, and they perform a vital service. I have no problem with drug companies making money - it costs billions to develop and especially get FDA approval for a new medication. They should be able to recoup their costs, and make a little folding money.
I do have a problem with jackholes making millions because they convinced a jury of their jackhole peers that they deserved to get $20 million in punitive damages because of something that no doctor could have prevented, or came up short on the odds. Nothing in life is certain. (Now, if the doctor was drunk, sue away....)
I do have a problem with government setting prices for the whole industry, and for all other kinds of intrusive regulation. My cousin used to work for a hospital, and the nightmare stories he told were unbelievable. The hoops that every part of the industry must jump through are staggering.
There has to be someway to straighten and simplify the whole thing. And tort reform would be a great start, eliminating one of the biggest costs for medical care for everyone.
The second point is the demographic change that will hit full force as the boomers start retiring in large numbers. This single fact dooms every old age entitlement scheme already in existence or merely in the planning stages. Entitlement means that those eligible get their money regardless of whether of any other needs the government or the rest of the country have. When the old reach a certain percentage of the population, the system will as a matter of course bankrupt itself because it will cross the threshold where the working population contributes enough in taxes to fund the outlays to the old.
Unless these programs are fixed, we are screwed. Privatization is one option. Raising the age of eligibility is another idea. Means testing is necessary. But something has to be done, or we will end up by 2050 paying all of our money right into the pockets of the old. Because it is damn certain that the boomers will be there with their hands out.
And we need to do something soon, because of point number one - seeing as the health industry is such a huge part of the economy, if it gets screwed up, the whole effect on the rest of the economy will be, I don't know, large. There are many ways that it could get screwed up: panicky regulation could either regulate it into stagnation or nationalize it. Increasing inefficiency and corruption could bankrupt key parts of it, leaving the system in ruins. Or, there could be piecemeal collapse, for example if malpractice insurance becomes to expensive, there will be no doctors - they will move to where they can practice and make a living.
The health industry must continue to make money in order for it to be the wonderfully effective thing that it is. It must continue to attract the best and brightest. What we need to fix is not the doctors and nurses, or even the drug companies. In principle, health insurance is a viable prospect. What we need to fix is the government side of the beastie, both in terms of regulation and heath related entitlement programs.