6 Cultural Reasons for Our Health Care Policy Mess

Arnold Kling

1. The American middle class does not believe in saving up for health care expenses. The idea that you should have $10,000 – $15,000 set aside for the occasional acute medical episode is abhorrent. The idea that you should save up for the inevitable medical expenses of old age is abhorrent. We are not Singapore.

2. The American middle class does not believe in paying taxes in order to support people who are very poor or very sick. We are not Denmark.

3. Americans are not willing to say, “The proposed treatment for this problem is not worth the cost. The individual should accept lower-cost treatments and live (or perhaps not live) with the consequences.”

The result of our cultural attitudes towards health care is an economy that spends 1/6 of GDP on health care, with nobody wanting to spend 1/6 of their income on it.4. Americans, and especially health care providers, do not want to think of health care as a commodity. The providers want to be paid, but they do not want to think of themselves as selling their services, so the payment comes from third parties and the price is hidden to consumers.

5. Americans are not willing to give up being the “early adopters” of new treatments, which are often much more expensive when they first appear than when they have been available for many years.

This was not as big a problem 40 years ago, when health care was a smaller share of the economy. It has grown larger because of new treatment options available. These often involve medical procedures that require expensive equipment and highly trained specialists. That is why I called my health care book Crisis of Abundance. As an example, I know someone with Parkinson’s who is getting “deep brain stimulation.” This is an incredibly exotic procedure, requiring a very powerful MRI machine, a highly skilled surgeon, and uniquely trained technicians. But it is a very promising treatment for a very difficult disease.

6. Americans seem to be more willing to spend public money on medical services than on public health. But I would think that there is more bang for the buck in getting people to change unhealthy lifestyles than there is in trying to treat the consequences of those lifestyles.

Put together these cultural traits and you end up, in Josh Barro’s words, with an economy that spends 1/6th of GDP on health care with nobody wanting to spend 1/6th of their income on it.

Republished from Askblog.

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