What I do have an opinion on is the context of the argument. The debate at the water cooler IS about how health care should look tomorrow. It SHOULD be about how health care should look in 20 years. The fact is that the current health care system does a pretty decent job, today and it will continue to do so tomorrow. Of course it's not perfect, but it's not bad. The rich get GREAT health care, and hospitals don't turn away emergencies even for the uninsured (most of which enjoy welfare or CHIPs opportunities). The problem is the current system is built for health care costs that represent about 16% to 18% of GDP. That's not as bad as it sounds, and it's downright cheap when you look in to a crystal ball. The congressional budget office projects health care costs will be 25% of GDP in 2025, 37% in 2050 and 49% in 2075. If that sounds like a long way off, recognize that if it's not still in your lifetime, it's likely still in your child's lifetime. If/when healthcare is 25%+ of GDP more pension funds will go bankrupt more employers will stop offering insurance and more unions will be disolved. The current system will go from 10% uninsured to much much much higher.
Why are healthcare costs headed so high? To be blunt here, healthcare costs become 49% of GDP because people don't die. Things that used to kill people instead are treated by expensive medicines, prolonging their life so that they can need to be treated for something else. If that sounds harsh, it's because it is. I'm harsh because I don't believe this country has time to talk about this issue in "nice" terms. It's people being queasy about the real issue here (what health care will look like in 20 years), that is destroying the water cooler debate in this country.
So what are our options for healthcare 20 years from now? I think there are two of them, and I will outline them below. What you can't look for from me is advice on which one is best. They both suck, but part of the price for living longer then mother nature intended, is being stuck with tough decisions.
- We institute a socialized health system. The system controls drug and treatment prices and options. This stifles innovation in the medical community because would be innovators aren't inclined to produce medical advances that the government won't pay for. The rate of increase of spending relative to GDP levels off. Everyone has good healthcare, given current technologies, but the life expectancy stops increasing. By 2100 the average life expectancy of a rich person is 110 years and for a poor person it is 100.
- We keep healthcare private. As lifetime costs of healthcare skyrocket for those who have elite medical insurance, less and less people have access to top-of-the-line service. Those who don't have access to the higher plans either have lesser plans or are uninsured. With pension funds and companies going bankrupt under promised health care that exceeds the costs anyone could have projected, more and more people become uninsured. This increases the cost of insurance, and the cycle repeats. By 2075 only a handful of people have access to health coverage that covers all life sustaining procedures. Those handful though, have access to the medicine of science fiction novels. By 2075 the average life expectancy of a rich person is a remarkable 150 years but for a person in remains largely unchanged from 2009 at around 85.