Apologies if this has been diaried already, but I was a little surprised not to see it mentioned yet. In the latest edition of the New Yorker, Atul Gawande has written a piece under the "Annals of Medicine" heading, entitled The Cost Conundrum.
I am not an expert on health care by any means. It's not even a topic that I particularly follow or get hot under the collar about. The discussion often gets too ideological for me. My suspicion is that the best answers don't fall cleanly in one political party or another or one set of tactics or another.
What struck me about this article was that it's not particularly ideological either, but gets to the part that DOES interest me about the healthcare discussion, namely what in heck exactly has caused healthcare costs to rise so sharply.
You should read the article to get to the full discussion--it's fascinating. I personally liked the mental exercise of imagining a woman haggling with her surgeon over the price of her surgery. But the heart of the matter seems to be that health care is expensive largely because many health care professionals (the examples in the piece were not just about doctors) overtreat their patients, with no difference in outcomes. Gawande seems to implicate certain doctors, who see their patients as cash cows, and certainly, one could write whole treatises on the medical profession's odd and uneasy relationship with money. However, I suspect that patients are also complicit in this mindset to some degree. Even if presented with evidence that spending more money isn't helpful, many people (maybe not you, and you know who you are) would be nagged by the sneaking suspicion that they really would do better if they did more. Certainly, most are not in a position to argue with their doctors on this point. Upon reading this, one suspects that the what's needed isn't just mechanics, whether it's single payer or a public option or whatever--it's a whole change in the culture surrounding medicine and expectations--in this, politicians are lagging indicators. Now if the various tactics lead to this goal of getting people to accept that the best medical care is not the same as more medical care, that's all well and good, but it makes sense, in a common sensical way, that this change of mindset ought to be the ultimate goal--that handled competently and intelligently, less healthcare is often better healthcare, not rationing. And one can't help but believe that the increased costs of health care are directly related to the number of uninsured--or to put it another way, if care were cheaper, it would be easier to offer it to everyone.