A Few Words on Health Care Reform in the U.S.

Chart from here.

The United States spends far more on health care and has worse health outcomes than most other westernized nations. These are facts: (a) the U.S. spends more; (b) people in the U.S. get worse results overall. Something is wrong.

There are a number of areas that need attention. For example, in the $3.8 trillion 2013 U.S. budget (which, for the federal fiscal year, began in October 2012) 21% of the total -- $811 billion -- is slated to go just for Medicaid, Medicare, and children's health insurance. The Obama administration passed a comprehensive plan to address health care which the Republicans have aggressively opposed. Numerous independent organizations have looked at this and estimated that costs ultimately go down (one purpose, after all, is to bring health spending under control) while health services improve.

The Obama plan is only a first step. It will not bring costs down sufficiently, and it does not address all of the problems. Some of these seem obvious: there is a missing mechanism for competition in the provision of critical health care services. One goes to the doctor or the hospital in the U.S. and pays what one is told, less insurance. There's no negotiating on cost or shopping around. Nor is there a check on what doctors and hospitals want to charge except insurance (which they can often exceed). There is, generally, no incentive to limit services, to avoid unnecessary services, or to provide less expensive alternatives.

It's no wonder there's lots of opposition; one need only follow the money. Which brings us back, with no need for comment, to the Republican opposition to reform.