Here are two takes. On the one hand, we have this graph from the Congressional Budget Office, which projects that health care spending will take up one hundred percent of America's gross domestic product by the 2080s.
The idea that we'll be paying more on health care than we produce strikes me as impossible. But again, we're operating under the assumption that government-passed health care reform cannot happen politically, ever. So what happens, instead? James Kwak at Baseline Scenario unpacks that dystopia:In a capitalist economy, the thing that is supposed to keep prices in check is the buyers. If someone offers me a product that costs more than it is worth to me, then I won't buy it. But we can't count on patients to play this role in health care, because there is no way to make patients internalize all of the costs of their care; they simply don't have the money. Furthermore, most people don't understand the health production function (the relationship between treatments and outcomes), so they don't have the ability to select treatments that provide benefits that are worth their costs. (And, in many cases, it's not obvious even to professionals that a treatment isn't worth the cost; it's only obvious when you look at the data in aggregate.) ... The only payer with any real negotiating power is Medicare. The private payers have little ability to control costs. Or, if they have the ability, they aren't exercising it.
In short, prices will only go up. As a result, the cost of health insurance goes up, and the market finally kicks in in the crudest possible form: people who can't afford it become uninsured. At some point, if we have enough uninsured people, the health care industry will hit a point where it cannot increase revenues anymore, because it has fewer and fewer paying customers.
That's what happens in a world without marginality, you get absurdities like the population spending all its currency on one product. In a marginal universe, eventually the utility of additional health care spending would fall below other wants.
Here in France the National Health care is considered the best in Europe. The US spends 50% more and statistics show that the people are not as healthy. Congress has never had an overall strategy for health care, it is a patchwork of public (Medicare, Medicaid, Veterans) and private insurance.
And now there is the cry from politicians that it costs too much, but every idea proposed increases the costs. Our big problem is not the uninsured per se, it is the free riders who take advantage of the laws which say that no Hospital can refuse to give treatment. So, they ask, "why pay for something I can get for free?" So, their health bills are cost shifted onto those who pay for insurance. That is one of the reasons the costs are so high.
And during all the discussions, there is no mention of the malpractice abuse, lack of standardized medical records, self-dealing by Doctors who own MRI and other testing facilities and the administrative cost and red tape the Government mandates which takes more people than the number of nurses.
So, it seems Congress has no stomach to do what the French do: Levy a tax on everyone so there are no free riders, discourage malpractice lawyers, give everyone a memory card with medical data, give pharmacies the authority to prescribe drugs, and let nurses do the same.
So, Congress does not have solutions, they are the problem.
We need a comprehensive, long term answer, not more log rolling politicans who think another band aid is an answer.