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Why America 'cares' less about cost control than other countries

Tyler Cowen wonders why other countries care more about cost control in health care. The answer, in part, is that health care is on the budget in other countries, while that's not nearly as true here. That, arguably, leaves you in the same place: If Americans cared as much about cost control, they would put the health-care system on the budget, or they would tighten their grip around Medicare and Medicaid, which are counted in federal budgeting.

But the broader answer probably has fairly little to do with public opinion and quite a bit to do with political structure. If Truman or FDR or Nixon or Clinton had passed the health-care reform proposals they envisioned, health care would be on the budget and cost control would be a lot tighter and we wouldn't be asking this question.

But our system makes it very hard to get anything done, and so none of them managed that feat. You can chalk that up to American "values," but since Americans also elected all those presidents, it's not a particularly compelling argument. The difference between American and England is that in England, one of those leaders would have passed health-care reform and systematic cost controls would have been imposed decades ago, while in America, none of them managed to do so, and so spending just followed its natural path.

By Ezra Klein  |  October 30, 2009; 5:06 PM ET
Categories:  Health of Nations  
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I'm in favor of considering health care as part of the annual budget. How can we as citizens ask CBO to do so?

As you say, "If Americans cared as much about cost control, they would put the health-care system on the budget, or they would tighten their grip around Medicare and Medicaid, which are counted in federal budgeting." I'm all for that. How can we best move Medicare, Medicaid, and other health care issues onto the annual budget??

Where is Nancy Pelosi? I'd plead with her to put Medicare, Medicaid, and other health care issues onto the budget! Only the House can raise taxes -- so we need Nancy Pelosi to help us do exactly what you propose. I'm disappointed that she has failed us by cow-towing to Republican whims: if we could only have a tax increase, we could provide health care happiness to every American and could insure continued victory of the Democratic Party.

Instead, Pelosi attempts to appease Republicans and other non-liberals by attempting to conceal a modest tax on wage-earners as excise taxes and employer taxes. If we care about our fellows, we would WANT to pay a bit more for their happiness. Why do Republicans want to keep money for themselves? We should all share our wealth and participate in the commune of happiness.

Posted by: rmgregory | October 30, 2009 5:48 PM | Report abuse

So I guess this is the reverse of 'starve the beast' war cry of Conservatives: - 'put the beast - health care entitlements - on steroid of tax payer money, then taxpayers will bother about controlling those steroids!'.

Why it may (not even so sure about that) work in other countries and not in USA because there is something called Bernanke Printing Press and the thing what it does is it keeps on printing those notes with images of our various past presidents.

Being a reserve currency, the primary and implicit contract with rest of the world is American Congress will be prudent in managing in costs. Anytime, this assumption is undermined, we are inching towards Banana Republic.

I understand the argument by many learned economists that rest of the world is still buying our debt because they have pegged currency to Dollar (Yuan in specific) and it is in their self interest.

The question is how long can that last? Agreed over years the decline is to be. But over years existing entitlements and potentially new entitlements are going to make the problem severe.

Posted by: umesh409 | October 30, 2009 5:52 PM | Report abuse

There's no cost control in this legislation, Ezra. To suggest that we are now on the correct path is laughable.

Posted by: bmull | October 30, 2009 7:32 PM | Report abuse

Please stop using England as a synonym for the United Kingdom. We have a National Health Service. It's not the English Health Service.

Posted by: abdoujaparov | October 31, 2009 8:01 AM | Report abuse

Heh, so if I get you right, it's all a circular argument and any and all conclusions as to the differences between American society and the rest of the world are therefore null and void?

Many anthropologists see the USA to be quite separate from European culture you know. And I tend to agree. The constant angst had in the US over government is quite over and done with in the rest of the industrialized world.

Now, there are some exceptions with "soft" states like yours (Italy...) but none you really would care to be in the company of. Unless you like your head of state to be inept, corrupt and amusing (likes of Palin, Berlusconi) who's only essential function would be to leave their underlings alone and divert some pork now and then. Society just carries on regardless, making do with its own arrangements.

And that's one way to do things. But a modern and evolving society is just too complex *not* to have a strong, democratic and competent state. The alternative is a steady build-in of dysfunction and rentseeking until the whole comes down with a bang or the mob takes over (like it is doing in Italy).

So what has this to do with health care? Nothing, except there are a lot of americans that didn't ever see a dysfunctional policy they didn't like, as long as they were or could get on the right side of it.

The "American Dream" of late seem like a great game where the winners end up rewriting the rules so that they can keep on winning. Better you do it to some loser (by definition, as he didn't win!) than he/she do it to you right?

Posted by: Upandaway1 | October 31, 2009 9:07 PM | Report abuse

--"[O]our system makes it very hard to get anything done"--

It was purposely designed that way, Klein, to keep creeps like you from imposing their petty, ill-advised, incompetent whims upon their fellow citizens. As it turns out, it is still too easy to "get" things "done".

Posted by: msoja | November 1, 2009 9:09 AM | Report abuse

I agree with Klein's premise about Americans being less concerned about healthcare costs than other countries. We have the highest per capita healthcare costs of any nation on the face of the planet. If Americans were truely concerned with healthcare costs, we would have reformed the healthcare system sixty-years ago and would not be in our present predicament with spiriling healthcare costs out of control. All the talk about health reform being too exspensive is wrong and disingenous. We have evidence from other industrialized nations that prove that reformed healthcare systems that are operated on a not-for-profit basis and are oriented towards disease prevention and wellness are very cost-efficient. A single payer system is cheaper and more effective than our present system. The opponents of health reform are using costs are a pretext to obstruct and forstal healthcare reform.

Posted by: abishop2 | November 1, 2009 4:38 PM | Report abuse

--"If Americans were truely concerned with healthcare costs, we would have reformed the healthcare system sixty-years ago"--

Sixty years ago, the U.S. health "system" was still essentially a free market. It's somewhat silly to refer to something so unstructured and unregulated as a "system", but today's discussions are rife with such nonsense. Around sixty years ago, what began was an intrusion into an otherwise healthy and very productive free market. Costs then were completely unremarkable.

It has only been with the slow establishment of a "system", supplanting and displacing the free choices of an erstwhile free population, that the designers and managers of the new "system" have run into and created one problem after another.

--"A single payer system is cheaper and more effective than our present system."--

Not even that adolescent cheerleader of nanny despotism Ezra Klein thinks the current monstrosities working their way through the chambers of infamy will create a "cheaper" "system". His most daring euphemism these days is that new legislation will "bend the cost curve", a phrase that tickles the ears of his fellow airheads, but says absolutely nothing.

Posted by: msoja | November 2, 2009 9:31 AM | Report abuse

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