We've tried bending the healthcare cost curve before

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Pretty much everyone agrees that healthcare costs in the US are out of control, way too high and getting higher. And pretty much everyone agrees that it's someone else's fault.

As nation's get more prosperous, they spend more on healthcare. This is universal, and healthcare costs have been climbing everywhere in the world, no matter what the system of reimbursement or set of controls on use.

But the US is a definite outlier. Its costs are noticably higher than that of other nations, as this graph, from The Incidental Economist, shows:

There are two basic types of solutions, according to The Incidental Economist:

  1. Each of us makes individual choices that lower these costs. We use less, we choose more wisely, we get "skin in the game", we maintain our own health through decent diet and exercise.
  2. The government forces us to use less, by rationing, controlling choices, disallowing certain expensive procedures.

How likely are either of these to happen? We each want others to minimize their healthcare usage, just as we hope other people with cars will stay off the road so we will have a quicker commute. And no one wants actual restrictions imposed on anything except what other people use.

Remember, we did have a successful and effective system of healthcare cost control, back in the 90s. It was called managed care. Remember HMOs? Remember that they controlled healthcare costs? Remember how pissed off everyone got?

Remember movies where desperate men got transplants for their children at gunpoint (2002's John Q), and mothers cursed managed care because their child had asthma (1997's As Good As It Gets--incidentally, the most depressing movie title ever)? These were easy applause lines. Everyone got how awful HMOs were.

It will all happen again, no matter what the reform. Individuals benefit, while the system becomes unsustainable. It would be nice to find a specific villain.  But, while there are always small villains that can be called out and punished, the only big one around is...us.