How much of our national healthcare bill could be eliminated if government got out of healthcare (both as a provider and as a regulator) and the free market was allowed to prevail?
Clearly the answer is "a lot," not least because the government directly finances 40-odd percent of care and influences other spending in myriad ways. The more interesting and important question is the degree to which removing government involvement to lower spending would be a good thing.
The primary reason for and goal of government involvement has been pretty simple (and successful): vastly increasing access while maintaining quality. For many decades the feds, and to some degree the states, have tilted the playing field toward health care at the expense of other economic sectors, such that vastly more dollars flow there than--presumably--would without that intervention.
Some of the ways are very straightforward: they've taken tax dollars and directly bought care for those wouldn't otherwise be able to get it (e.g., the old, the young, some of the poor). That right there is well over a trillion dollars purposefully re-directed into health care to give tens of millions of people access.
Starting in the '40s, the federal government decided we didn't have enough hospital beds per capita so it spent decades financing the building and expansion of private hospital capacity. Good from the perspective of increasing access, particularly in rural areas: more local hospitals, more availability of care locally, more local jobs. The flip side is that now, over half a century later, we find that perhaps we've overextended ourselves. We've got a fair number of hospitals out there, particularly in rural areas, that don't seem to be economically viable. Closing them saves money but has serious public health and access implications.
The federal government has taken responsibility for financing physician training after med school, in part because the industry doesn't seem particularly interested or capable of financing that itself. But the funding available for that training and the necessity of undergoing it naturally limits the number of new physicians we can produce. There's been a lot of talk in this thread about barriers to entry and certainly licensure and training of health professionals is a big one. But of course there is a public health and quality reason for those barriers. On the other hand, there's great interest today in making greater use of cheaper mid-level health care providers instead of physicians wherever possible.
And of course the feds very famously have used the tax code to privilege dollars spent on health care (either those squirreled away for OOP expenses in an HSA, or those set aside by an employer to directly pay for care) over dollars spent on other goods and services. Paying an employee in health insurance has been more attractive than paying an employee in equivalent wages for 70 years.
But the conceit here is that somehow this is artificial or we didn't want this. That we wish the government hadn't been pumping money into (and encouraging us to pump our money into) building and sustaining the capacity our system has today. But these decisions weren't made in a vacuum. And the suggestion on the table today from some on the left that perhaps we ought to now use the government to pump money
out of health care and pare back the level of capacity we enjoy is often met with howls. So it's tough to be sure we really have more health care infrastructure and capacity than we want. Everybody's against health spending, they're just not against any of the things we actually buy with our health dollars.
If we pulled the government out tomorrow and settled on a health system financed by, say, $3-5K a head per year on average directly provided by households, that system looks a hell of a lot different than the one we've got today. Maybe that's the health system people really want: one that's ultra-lean and low-rent. But I sort of doubt it.
I like how you avoided the question.
