As someone who’s generally disposed to favor free-market solutions to a wide variety of problems, I’ve always been a bit troubled by the observation, often touted by progressives, that here in the U.S. we manage to spend a hell of a lot more per capita on healthcare than various countries where it’s socialized to some degree or another, without much of anything to show for it in terms of health outcomes. Yeah, I’m familiar with all the libertarian critiques of the far-from-laissez-faire status quo in the U.S., such as the way tax incentives have inefficiently tied health benefits to employment, and I find much of that plausible. And obviously there are differences between the relevant populations: If Americans eat more twinkies and exercise less than Swedes, they’re going to be less healthy however good our healthcare system is—and to the extent that’s a tradeoff people make knowingly, I’m disinclined to consider it a problem, as such.
Still, all that never struck me as totally satisfactory. Even after accounting for those factors, if socialized medicine is such a bad idea, how come it often seems to achieve as-good-or-better outcomes at lower cost? So over dinner with Dr. Dad in Chicago last week, I posed him just that question.
His answer was something I hadn’t thought of: “People in America think death is an option.” He meant that we spend huge amounts of money in the last few months of life on futile care—”where there’s life there’s hope” and all that—buying a few more weeks or months of bedridden survival at an enormous cost. Because of the dreaded “rationing,” countries with socialized healthcare don’t approve that sort of expenditure. But it doesn’t end up showing in the statistics, because for the most part it’s money wasted—all the pricey pharmaceuticals and high-tech treatments aren’t going to transform death into a lifestyle choice.
To say it’s “wasted,” of course, assumes it’s not the case that people really value the actual benefit they get from that “futile” care (or even the expected benefit given the chance of rare spectacular results) at the level their “revealed preferences” seem to indicate. But I think that’s highly plausible for a variety of psychological as well as institutional reasons I’ll assume readers can flesh out for themselves.
So here’s a puzzler. On the one hand, we want to create a culture in which people take a slightly more sane attitude toward death, acknowledge that (so far) they are not gonna live forever, whatever Oasis says, and let go when the end is sufficiently obviously nigh. But we also want to avoid the scenario assisted-suicide opponents worry about, where this mortal coil gets coated in Crisco, and the end’s not so much a shuffle as a slip and slide that begins with a solicitous nudge. Thoughts?