Dealing with the poor is a problem for the gubmint, as they can't enforce any discipline on welfare recipients. For instance, drug use among the poor probably causes a signifigant part of their health problems, but the ACLU would wig out if we started mandating drug testing for them.
It sounds good...but it isn't true.
Certainly technological advance has improved, and in cases such as you cite, made certain kinds of health care cheaper. But if you look at the actual costs of all the elements which make up modern medical care you find they are increasing - radically.
What is actually happening is that the quality of healthcare is going up
Very true...if you can afford it.
. The problem is that w/ third party payers, people are willing to spend large sums of money for minimal improvements, so we are spending more.
Only half true. When people are self-payers do they forego minimal improvements or necessary services? The best evidence - from emergency rooms - is that the latter predominates by far.
Try looking at the cost of delivering a baby in a hospital. It's expensive. Do we really need all that stuff? I mean people can deliver babies at home by themselves. The answer, I think, is a metaphor for what we face.
Or look at the cost of treating cancer, or some of the diseases of age. In the past most people just dropped dead earlier. Do you want to consider modern treatment of such things as frivolities?
The middle class are the ones getting all that elective surgery
In Los Angeles most elective surgeons, like most lawyers, are located in the wealthiest parts of the city. I think that's true most everywhere.
drug use among the poor probably causes a signifigant part of their health problems
Poverty is the cause of the health problems of the poor - now and always. Drug use in the middle and upper classes is treated and not compounded by bad diets and overwhelming stress.