My answer to Harold Pollack’s question

Harold Pollack asked a good question, which I posted earlier. I promised to come back and answer it. Here’s the question again:

Over the past three years, we have experienced an amazing number of political, economic, and legislative trials. […]

Anyone active and attentive should be thinking differently about something important after having witnessed so much history being made so quickly on so many different fronts. Tell me–Have your own views changed on any basic issues of domestic policy?

My thinking on health care policy has changed in several ways. Here’s just one. As I’ve posted many times, the politics of cost control are hard, due to entrenched interests and posturing for short-term political gain. However, I’m now more willing to attribute one more cause to the difficulty: we’re generally not ready to face the issue.

Collectively, if not individually, we’ve revealed by our action in the doctor’s office and the voting booth that we don’t want to control health care costs as much as we might say we do. Oh, we love to pay lip service to it, until it’s our health on the line. It’s not my utilization that’s wasteful, it’s all those other people who are duped by their doctor, who demand the latest and greatest, or think everything should be free and available.

I’m skeptical. When faced with the health conditions and choices that the sickest among us face — those that account for the vast majority of spending — I am not at all convinced you or I would make decisions that save much money. We certainly wouldn’t welcome constraints that force us to. We don’t really want to be bound by the contract we seek to impose on others. Or, I don’t think so anyway.

At a deep level we don’t want to change our health care spending habits. The day we really do, we’ll overcome the other political obstacles to doing so. On that day, many more of us will start to tune out the noise (“death panels,” “rationing”). On that day, we’ll stop believing that easy solutions will fix everything (high deductible health plans, the totally free market for insurance, Medicare for all).

Today is not that day. Health care cost control is hard. It’s made harder by the fact that we aren’t serious about solving it, or not enough of us anyway. I’m beginning to think we like it that way. If so, we should embrace that fact, stop denying it. And then we should pay for what we use, rather than borrow our way into oblivion.

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