The biggest issue facing America

Read more about Singapore's healthcare system here: http://econlog.econlib.org/archives/2008/01/singapores_heal.... http://www.american.com/archive/2008/may-june-magazine-conte...

But coming back to Earth, such a plan could never happen. If you approach the problem from the perspective of a hypothetical policy advisor, there is very little that is both a) politically possible and b) would actually improve the system. Raising the caps on medical school enrollment is an obvious fix that would reduce costs without costing taxpayers anything, but the doctors will try their hardest to block it. A mandate to buy insurance makes sense in theory, but in practice the required level of healthcare to buy gets set way, way, too high, and so a mandate ends up being a huge transfer from citizens to the healthcare industry. There are dozens of other examples. Our system is f*ed up for a reason, and until the political system is reformed, policy reform is impossible.

In reality, healthcare spending will continue to rise until it simply cannot rise further. The spending will be distributed according to political power.

There will come a time when technology will make it possible to keep someone alive indefinitely so long as you spend exponentially more money to do so. Everyone has been conditioned to think that they deserve the best healthcare regardless of what choices they've made in their lives. They will not accept that someone that has more money lives longer.

The only option is rationing. Either the naked market does it or the government does it. The perceived (and often genuine) inequality of the market practically guarantees that the voting public will demand the latter. This means that someone steps in and essentially decides who lives and dies. Some agency will perform the brutal calculus that decides that a Nobel winning scientist is a better investment to keep alive than a retired truck driver. Historically this has a terrible track record. Anyone willing to wield this power is usually the last person you'd want to actually do so.

Eventually technology will take us through this transitional period into a better time where healthcare, like food, is cheap enough that everyone can have as much as is needed and the only shortages will be caused by politics as is the case for food now.

It seems the best thing we can do as a species is knuckle down and drive through this transitional period as fast as we can. I'm kind of hoping that this current recession produces a few more of the "knuckle down and drive through" types as they seem to be in short supply these days.

You can go about your business.

Move along, move along.

Right now, I'd settle for just the right to say "I'd like a quadrupal shot of morphine please so that an extended stay in a miserable nursing home won't bankrupt my whole family."