The Agenda: Why does health care cost so much?
One theory is that, traditionally, medicine could not really do much for the sick and injured. For almost all of human history, science and medicine knew nothing of many things. Anesthesia and antiseptics for example, or what was a “normal” blood pressure or heart rate. “Doctors” could be “real” or they could be “quacks” and you couldn’t tell the difference. Surgeons could lop off arms or legs with a fair chance that the patient would survive. They could do nothing about deep puncture wounds to the thorax. They could administer heroic doses of laxatives and they could “bleed” patients to restore the balance of humors in the body. As for psychiatry, Ben Franklin once helped out his sister by paying for her disturbed son to be chained up in a farmer’s barn to keep him from harm.
Then, from the mid-19th Century onward, a medical revolution occurred. It was just as dramatic—and probably more important—than the various political revolutions that have enlivened journalism over the same period. Invasive surgery became safe and commonplace. Drugs treated many diseases. Vaccination warded off a host of terrible killers. Then, in the second half of the 20th Century, still greater marvels appeared. However, these ones were vastly more costly than the earlier innovations. Organ transplants and fertility treatments, for example, are very costly. Chronic illnesses in a population with an extending life-span is a new development. In sum, modern medicine is just really expensive. The best solution is to socialize the costs through government taxation and payments to providers.
Another theory is that none of this is the real explanation for high health costs.[1] It isn’t ALL medical costs that are so high. It is only AMERICAN medical costs that are so high. On a per capital basis, health care is about twice as expensive as it is in other advanced countries (i.e. Western Europe, Japan). European doctors with comparable education and skills earn about half of what American doctors earn. Members of the administrative hierarchy in hospitals and medical networks earn high salaries. Medical tests, surgeries, and prescription drugs are far more expensive in the United States than they are elsewhere.
According to this second theory, if you want more affordable medicine, you’re going to have to take it out of the incomes of the health profiteers. This means everyone from your GP to the pharmaceutical companies. Trying to compress incomes to cut costs for consumers (patients) will involve battling powerful entrenched interest groups, everyone from the American Medical Association to Big Pharma.
In all of this, the health insurance industry plays the Bad Guy. They’re the ones who interact with customers/consumers/patients. Often they bring bad news. Some charge is denied, or you still haven’t exhausted your out-of-pocket obligations, or you need to get your doctor to re-authorize some prescription that you’ve been taking—and will be taking—for years. In truth, health insurers make a profit that is less than half of the average profit for corporation on the S&P 500.
It is interesting that none of this has come up in discussion of Secretary of Health and Human Services nominee Robert F. Kennedy, Jr.[2] What could/will Trump force through?
[1] “The reason health care is so costly,” The Week, 27 December-3 January 2024, p. 14.
[2] “RFK Jr. softens positions amid Senate scrutiny,” The Week, 27 December-3 January 2024, p. 4.
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