The American Health Care Money-go-round

by Rob Horning

14 April 2007


Ezra Klein linked to the chart below, a graphic representation of the money flow through the American health-care system. As his commenters point out, this is a streamlined portrait, and the reality is actually much more complicated.

This makes it clear how many entrenched parties would need to be “disintermediated” before any progress could be made toward a simplified system, which would not only save American tax dollars but would remove the disincentive from seeking medical care that’s created by the complexity and confusion. Of course, the confusion may be a feature rather than a bug, meant to accomplish precisely that (just as voting registration is sometimes made more complex to keep the wrong sort of people from voting). It heaps shame on those who need medical attention but can’t afford it, as if being sick in the first place wasn’t already troubling enough. Instead we built into the health-care system assumptions that (a) health insurance is necessary to use as bait to keep people productive and working institutionalized sorts of jobs (ie insurance is a management tool, not a social service) and (b) people must be assumed to be abusing the health-care system (for who knows what perverse reason) and should be treated with suspicion.

Perhaps the burdensome health-care system is just a reflection at the institutional level of the fundamental conflict that haunts health-care provision—a patient comes in with a selfish investment in the unique severity and significance of his symptoms, and the system must gently remind him that there are scads of people who are just as sick, and there is nothing special about his mortality. Does the American system mystify that conflict and lessen its sting? Would a more transparent payment system, organized more clearly for society’s benefit, remind us all too much just how minute we and our medical problems are when compared with society as a whole?

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