One reason I am despondent about the (risible) candidate lineup this election year is the health care debate. Obamacare should definitely be scrapped, but neither side has had the guts to lead a truly honest discussion of what health care changes should be made.
Instead of pointing to specific problems and their possible solutions, both side have stuffed this outsize bundle of issues into a tiny box labelled "Health Insurance." That's the cure, they say. Nationalized Health Insurance! No, Vouchers for Health Insurance! Both sides are desperate to create a Potemkin Village picture postcard where all Americans can simply hand an insurance card to a receptionist and all health care problems are solved.
Both sides are lying to us and both sides lack guts. Insurance is the least of our problems and should be the last thing we address. Suppose we start with this instead:
Treating cancer has never been cheap, but today, the price of each new treatment seems to outpace the one before, with little bearing on its efficacy. According to figures from insurer United Healthcare, a standard cocktail of drugs for treating lung cancer used to run about $1,000 a month. Today’s regimens cost from more than $6,000 to almost $10,000—for about two more months of life. “There is no such thing as a cancer drug coming on the market that is some sort of regular drug price,” says Dr. Peter Bach of Memorial Sloan-Kettering Cancer Center in New York, who studies the impact of cancer costs on U.S. health care. “They’re all priced at spectacularly high levels.”
Why is nobody investigating the cost of treatment? Shouldn't that be a good place to start? It has always struck me that the real question isn't "How can everyone have great health insurance?", but Why do we need health insurance at all?
No one has suggested we need 'food insurance' or 'clothing insurance,' even though, like medical care, food and clothing are basic necessities brought to market by an industry. In the aftermath of natural disasters those who sell food and water to a disaster area are often accused of price gouging. Some states even have laws prohibiting price gouging. They acknowledge that in the wake of a disaster the purveyors of basic necessities have a captive market.
Yet somehow, medical care always gets a pass. Its cost can never be questioned:
In 2004 researchers tried to test the relationship between a drug’s development and its final asking price. In the Journal of Clinical Oncology, the scientists concluded “that the drug companies are not pricing their drugs to recuperate losses associated with research and development, marketing, and operating prices, but rather [the average wholesale price] depends on what the market itself can bear.”
“It’s a marketplace where the seller has all of the control,” says Bach, from Memorial Sloan-Kettering, because private insurance companies and Medicare—the largest purchasers of drugs—are powerless to bargain for a less expensive deal. “Prices are high because they can be,” Bach says.
This is not the magical, unseen hand of the market. This is an unnatural economic arrangement that gives the seller all the power. It's an arrangement that goes beyond cancer treatment to include everything from the cost of MRI exams to the price of antibiotics.
This should have been the first line of investigation for those reforming health care. If necessary, Federal subpeona power should have been used to tease out the price gouging from the actual costs of doing business. Instead, both parties have closed their eyes to the non-transparent pricing of medical care and concentrated on propping up the system with either vouchers or nationalized insurance.
Neither party has offered any solutions because neither party has the courage to ask serious questions.