This is actually a huge problem, one that I have never seen discussed. It explains why the Congressional GOP won’t REALLY do anything to stop Obamacare, and also why they have no other ideas - because there ARE no other ideas.
Starting in 1965, we (I started medical school in 1972) have built a gigantic edifice of modern medical care, certainly the best in the world by far - using OPM - other people’s money - (people other than the patients or their families).
Look at the video depiction of the hospital where Vito Corleone was taken after being shot in the Godfather - that level of sophistication is what a true free market is willing to pay for. By “true free market”, what I mean is what willing patients and their families will pay out of pocket at the point of service.
Everything else - MRIs, CT scans, joint replacements, implantable pacemaker/defibrillators, mobile ICUs, heart surgery involving bypass, modern (safe) anesthesia, GI endoscopy, laparoscopic surgery, cures for lymphoma and certain leukemias - all of that would require tens to hundreds of thousands of dollars out of pocket at the time of illness, and most people could not or would not do that.
Enter Medicare and Medicaid. They pay, using OPM, for ANYTHING AND EVERYTHING that we, our medical device manufacturers, and translational research can think of (and they pay for the research, too). Yes, there is excess, and yes, given the general competence of government workers, there is fraud, too.
But most of this cost is fixed and most of it is beneficial. Imagine you live in rural NH, and you wake up at 1am on a snowy night in February with chest pain. You dial 911. Within 15 minutes, there is a mobile coronary care unit in your driveway. Within 20 minutes, your EKG is sent via either a cell tower or satellite to a heart center 60 miles away. The PA in the truck has orders within a half hour to administer a cloned protein that costs $10 000 via an IV. It doesn’t work, so you roll to your local hospital helipad, where a chopper picks you up. You are at the heart center by 3am. The entire cardiac cath team meets you and goes to work. By 3:45am, they see that angioplasty is not an option, so you go down the hall to the OR, where the surgical team is waiting for you. Using a small incision and microsurgical equipment invented here in the last five years, they bypass your 95% lesion, and your heart is free of damage as you watch the sun rise.
Now, the cost of all this stuff on standby, just waiting for you or your neighbor, replicated as it is all over the country, is in the trillions. The simple overhead dwarfs the cost of the actual treatments. And all of it - every single bit of it - exists because of Congress’ promise to print or borrow enough money to pay for it, since they know people can’t pay for it themselves and are not willing to pay taxes at a level sufficient to nationalize it.
That’s what Obamacare is all about - it’s a way for Congress to escape from the cost monster that they themselves created before everything comes crashing down. And they have very cleverly offloaded the responsibility for who gets what to the Independent Payment Advisory Board, which will shortly be offloading it to hospitals and doctors.
The alternative? Go back to 1964. The guy in rural New Hampshire gets up, takes Mylanta, calls his doctor who thinks it’s too snowy to go out, and he makes it or he doesn’t. (By the way, the odds of him making it are pretty good, around 85%).
Both the Republicans and the Democrats in Congress are partners in the something for nothing fantasy, and it looks like they are going to ride it all the way down to the ground.
Thanks to everyone for your responses.