WE Make Health Care Expensive

According to a NYT article in June, health care consumes 1/6 of the nation's budget, a figure that may double by 2035. If unchecked, health expenditures will outpace national revenue, which will ultimately lead to a debt crisis. Would extending health coverage to the uninsured exacerbate the problem? Not necessarily. This demographic tends to be younger and relatively healthier, so covering them won't raise costs that much. The key to curbing runaway costs is to expand the cost-saving measures already in place with the current Medicare program.

The current version of the Senate bill proposes to cut costs by improving incentives for cost-effective care and by encouraging evidence-based practice where doctors recommend only those treatments whose effectiveness is proven by research. But legislation alone may not be enough. Two recent programs on This American Life and NPR lay at least some of the blame for rising health care costs on patients who demand unnecessary services or sue physicians whose failure to recommend those services results in a negative health outcome.

The media reinforces the nation's collective sense of entitlement to expensive care by featuring heart-wrenching news stories about patients who, for example, won't live to see their toddler reach kindergarten because of some bureaucrat's "draconian" decision to deny life-extending (yet expensive) care. By employing these extreme case scenarios (known as the identifiable victim effect), the media perpetuates the demonization of "health care rationing" which skews public opinion against cost-saving measures.

Private health insurance plays an interesting role in the psychology of health consumers in that it allows patients to mentally shift the responsibility of costs to someone else. That someone else is usually an insurance company who will then compensate by raising premiums on everyone else. Basically, people are ignorant of the true costs of health care and feel entitled to receive it no matter what it costs. So even if they can't afford to pay $50,000 out-of-pocket for a specific procedure, they demand that someone pay for it without realizing who will ultimately incur the costs--society at large. And so health insurance premiums continue to rise and the nation is now on its way to spending 1/3 of its budget on health care within three decades.

As usual, the problem is multifaceted, requiring an understanding of all the intricacies involved and, quite frankly, an honest laying of the blame where it belongs. Unfortunately, the media as a whole fails to offer a detailed analysis of the complexities and a comprehensive explanation of the problem. What people get instead are fragments of information that blames soulless insurance agencies or money-gouging pharmaceutical companies without ever taking into account our own culpability.

Our American sense of entitlement to whatever we want, whatever the cost, is the elephant in the room that gets overlooked because we don't like to be criticized. In many ways, we deserve the dysfunctional system we have because we won't own up to our own contribution to the problem. But the Catch-22 of it all is that we place our faith in a media that fails to properly inform us and we don't realize the importance of seeking out some of the answers for ourselves. Our only hope is that our representatives in Washington truly understand the complexity of the problem and truly have our best interests in mind. Whether they do or don't will be reflected in the ultimate bill that gets signed.