November 17, 2002

Have recently been pondering the looming crisis in health care (and, perhaps, higher education). As both become relentlessly more expensive, one sees no end game other than either a return to the barter system (i.e. you do my double bypass and I'll fill out your taxes, which, by 2011, should be considered equivalent in terms of complexity), or a disorderly decline in quality and timeliness of health care (translated: higher rates of mortality). Health care costs are exacerbated by a host of monsters: malpractice suits run amuck, and bad behavior run amuck (resulting in 'crack-cocaine' babies and the need for AIDS cocktails)...but also by a host of neutral factors: like the increasingly high relative cost of human capital and the tremendous cost of new medical technologies like artifical hearts and the like. The usual thing to do in situations like this is to debate where the pleasure/pain point is - i.e. where additional taxes or costs do not lead to significantly higher benefits. What is unique to the health care field is that it is impossible to put a value on a human life. Whereas higher taxes may provide an afterschool venue for troubled youths and one could debate the merits of that, greater health care costs may provide saved lives, which is a very different debate. Complicating it is the boomer's obsessive desire to live forever (due in part to a lessened belief in an afterlife) and the very expensive life-extending measures that result...I believe the Church teaches that we don't have to go to unnatural lengths to extend life, but that devil is very much in the details. It seems it will be very difficult to arrive at a consensus in our society as to what extends life unnecessarily and what doesn't.

Concerning the human capital cost, Daniel P. Moynihan wrote years ago that the problem with health care and education is that new technology does not help make either profession more efficient. So while most jobs can be constantly made cheaper and productivity will rise, it does not happen with human-intensive jobs like teachers and doctors because computers and robotics don't help (in fact, the need for schools to have computers and health care to have expensive lasers adds to the price rather than subtracting).

So, how willing are we to become partial serfs to health care? And the general rule is that everything we give to the gov't to do becomes not less but more expensive. Thus to universalize health care should eventually make the current social security tax look like as harmless as a summer day (in the 1950s 1% was paid to social security 'trust' fund, today you and your employer pay 15% and it's in lousy shape). But I'm not sure there is an answer since the private sector has failed, and continues to fail.

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