A Jan. 5 New York Times article reported that health care spending grew in 2008 at the slowest pace in 48 years, only up 4.4 percent from the previous year (down from an average increase of 7 percent a year in the decade from 1998 to 2008). A Feb. 4 Washington Post article reported that health care spending in the United States grew by 1.1 percent in 2009 compared with 2008. While the slowing of health care costs growth may seem somewhat promising, it is shocking that health care expenses continued to increase despite the rest of the economy shrinking. Health care costs are gradually approaching 20 percent of the overall economy.
The idea that health care spending should take up 20 percent of the economy seems totally out of proportion and unsustainable (although one uncle of mine suggested that spending on health care may be money better spent than using that money for weapons). The costs continue to grow, while the number of uninsured continues to increase. The idea that government is going to take over health care is already here, at least in terms of paying for much of it.
The last presidential election and subsequent elections seem to have made clear that there needs to be an open consensus process on how to solve the problem. There is a growing minority of people who have poor access to care, and everyone agrees that the problem needs to be fixed. There is a shrinking majority who are paying heavily for access. Their costs continue to grow, and everyone agrees that that problem needs to be fixed, too.
The hard part is coming to a uniform consensus about what needs to be done. The solution will need to consider that there are no free lunches to fixing the problem. Patients can’t have unfettered access to any treatment at any price paid for by some third party — whether it is government or a private payer — if we’re going to reign in the cost of care. We’ll need to come to a consensus about which is the lesser evil: continued explosive growth in health care costs, rationing the health care options patients have, or making patients themselves more responsible for the costs of their health care decisions.