Health Care Spending

By 2017, spending on health care is expected to account for 20 percent of all money spent in the United States.

U.S. spending on prescription drugs, hospital care and other health services is expected to double to $4.1 trillion over the next decade, up from $2.1 trillion in 2006, a government report released on Wednesday found.

Despite relative stability in recent years, nearly 20 cents of every dollar spent in 10 years will go toward health care, National Health Statistics Group economists said in their projections looking at 2006 to 2016.

Yet conservatives will still look you in the eye and insist that universal health coverage is not the way to go, and that government has no business getting involved. President Bush insists that the U.S. health care system is the best in the world, and that the only thing needed to improve it is to treat employer-provided health insurance as taxable income, while providing tax deductions which he says will make insurance more available to the 47 million Americans who don't have it.

On Capitol Hill, the president's proposals have gotten a frosty reception. Democrats, who took control of both chambers of Congress last month, agree that health insurance should become more affordable for the self-employed.

But they say the biggest problem facing the system is the 40 million Americans with no health insurance and that the president's proposal would help only a small fraction of them become insured.

In particular, they point out that the deduction would not help taxpayers who do not itemize their income tax returns, especially low-paid workers who are the most likely to lack health insurance.

Look, if you're talking about shoes, cars, or tomatoes, then I'm right there with the conservatives. Free-market all the way. When it comes to health care, that position is a bad joke. Health care is not like any other sector of the economy. Without it, people get sick and die. Bush says the way to bring down the cost is for health care "consumers" to make wiser purchasing choices, the same way they do for shoes, cars, and tomatoes. What he doesn't seem to understand is that, when it comes to health care "products," there aren't a lot of options to choose from. Women don't have the luxury of shopping around for the cheapest mammogram.

Let's say Bush gets his way. He manages to destroy the employer-based health care system in favor of this private insurance scheme of his. Private insurers initiate a price war in order to sign up more customers. The health care service sector responds with a round of price cutting for its services to become "preferred providers" to the members of private insurance plans. All this cost cutting has to give somewhere. The insurers and the providers aren't going to sacrifice their profit margins for the sake of the health care "consumers." What has to give is the quality of the care that the providers provide and the insurance companies pay for. Then, there really will be cheaper mammograms on the market. They will be administered by technicians who are getting paid less than better-trained or more experienced technicians who work for "gold-plated" mammogram providers. They will use equipment that can be purchased for a lower price. They will be in offices that charge cheaper rent. The free-market certainly will force prices down, but the likely result will be a fragmented market of upper-, middle- and lower-tier "consumers," also known as "patients."

Under such a system as Bush proposes, upper-, middle- and low-income patients will be able to afford differing levels of insurance and health care, just as they can afford different types of cars. The wealthy will purchase Rolls Royce (or, as our president puts it, "gold-plated) private insurance plans. Middle income families will purchase health plans equivalent to a fully-loaded Honda Accord EX. The poor will take what they can get on the market (Daewoo health plan) or whatever is still available to them through Medicaid.

The rich will not only continue to get richer, they will get healthier, too. The poor will get sicker and die of things they need not die of. This is why is it so destructive to think of the health care marketplace as occupied by "consumers" rather than "patients."

Universal health coverage is the best solution. Free-marketeers don't like it because it contradicts their economic philosophy. To hell with their economic philosopy. People are dying who don't need to die. Universal health coverage evens the playing field for individuals and for businesses. General Motors is collapsing in part under the weight of providing health care for employees and retirees. They are not alone. Freeing the corporate sector of having to provide health care is a net positive, but the solution is not to place people at the mercy of the market. The market has no regard for anything but efficiency and profit. Under free-market theory, if people can't afford quality health care, they should die and make room for those who are younger, healthier and richer. Law of the jungle. That's great, unless you just happen to be someone who isn't rich and/or healthy. Then, the law of the jungle doesn't look so great.

Imagine being able to count on a 20 percent net increase in your household income next year. Now imagine a 20 percent average increase in the disposable incomes of American consumers. Imagine having that much more money circulating through our local, state and national economies. That's what we can look forward to if we craft a health care policy that thinks of people as patients, rather than as consumers.