Most of what is being written about healthcare is rather shallow and uninformed. I recommend an exception here, courtesy of Arnold Kling. One commenter on this post made an exceptionally insightful observation: the issues of healthcare costs involve far more than economic efficiency. There are deep ethical issues as well. The commenter said it well:
Nothing short of brutal, heavy-handed rationing can control health care costs. The problem with Kling’s voucher plan is that it makes this explicit. It would make each of us ration our own care (maybe half of us could cope with that). But it would also force people to ration care for their family members. I think most people know, deep down, that this must be done, but, come hell or high water,they will not do this individually. Just as people hate to take responsibility for their choices in the mate market, people desperately need a way to ration care while pretending they aren’t.
Governments fill this role. In Britain, NICE is the whipping boy. People rage at the bureaucrats so they don’t have to feel guilty for not dialyzing their demented octogenarian grandparents.
Maybe private insurance companies could ration care if they had the backing of the government (e.g. approved guidelines and procedures which make it virtually impossible to win a lawsuit against a compliant insurer).
Maybe doctors could enforce the rationing. They can pretend nothing more can be done. . . . I think the Swiss system may be something like this, though I’m not sure.
It takes two executioners simultaneously turning two keys to start a lethal injection machine. That way no one person can be held directly responsible for killing another. We get to pretend the “state” did it.
Controlling costs means denying care. Denying care means killing, even if we do it softly.
It’s worth noting that Public Choice theory says that politicians would never ever make rules for rationing. They will, of necessity, pawn it off on a bureaucracy. Maybe all those lunatics talking about “death panels” aren’t so lunatic after all.
UPDATE: Kling explains, with perfect clarity, what can and cannot happen, when, and why. Most informative!