The Grand Illusion
The recent debacle in Congress over the Affordable Healthcare Act is all too representative of an ever greater societal problem – the fact that far too much legislation and too many governmental programs are aimed at dealing with symptoms and avoid addressing the real underlying problems.
The issue isn’t really about healthcare insurance. It’s about the cost of healthcare itself. In 1970, the average American spent $380 on healthcare. In 1980, it was $1,180, but by 2013 [the latest data available], that cost had risen to $9,810. In essence, the cost of healthcare has increased at four times the rate of inflation, at a time when middle class earnings, adjusted for inflation, have remained roughly the same.
Then there’s the opioid crisis, which the media splashes everywhere. And yes, it’s a real and painful problem, but the root of the problem lies in the fact that we still don’t have non-addictive painkillers, especially for nerve-rooted pain. Yet the big push is to restrict the use of opiates, when there’s literally no other type of pain-killer available.
What about the high cost of education? Since 1980, the real cost of a college education has increased four and a half times the rate of inflation, and now the average debt of a recent college graduate exceeds $35,000. Students graduating from elite institutions or pursuing graduate degrees can easily end up owing more than $100,000 in student loans. Yet, as I can attest from both statistics and personal experience, that money isn’t going, for the most part, to college professors, not when average professor’s salary has increased by less than half a percent a year over the last thirty years and when the majority of new teachers are underpaid adjuncts. The problem lies in the fact that there’s been a huge increase in the number of students attending college and that state legislatures have refused to fund that increase in students and have passed the costs on to the students and their parents. At the moment, and as I’ve noted earlier, there are now twice as many college graduates each year as there are college-education-required jobs for them. Yet all the solutions proposed seem to be designed to bail out the states and to produce more college graduates for jobs that don’t exist, while neglecting non-college training for well-paying jobs that do exist and have shortages.
Another problem requiring a solution is the current U.S. air control system. There are more and more passengers, and more and more demands for passenger rights, but, so far, no one seems to be seriously looking at the underlying problem of a technologically outdated air control system.
I’ve just listed four areas, but, if I wanted to do the research, I have no doubt I could find many more examples of policy-makers and well-intended activists vigorously trying to address the symptoms of a problem, rather than the root causes.
Why does this happen? Largely, I suspect, because addressing the root causes upsets all too many apple carts, and is often initially far more expensive, even if cost-effective over time, while addressing the symptoms is far less controversial.
One of the most significant factors in the rise of education costs is administrative bloat, as you’ve pointed on several occasions. Some of the additional administration has been necessitated by the increase in “accountability” in the form of fairly random and useless measures demanded by the government (which leads back to your point by another fork) but a large component is the administrators just raising their own salaries, splitting off and adding new positions with similar high reimbursement. The commodification of education has resulted in the same issues it has in corporate salaries across the board.
This post goes right to the heart of many problems in the US for me. Short term-ism.
Specifically on health care part of the problem is that there is absolutely no transparancy on cost. When you decide whether or not to have the treatment, you do not know how much it will cost. When I ask a healthcare provider how much it is going to cost me they usually get defensive. They clearly don’t get asked the question very regularly.
People mindlessly accept treatment they can’t afford, which is not always necessary, which will make their health worse in the long term due to the financial stress it engenders. It is very hard to understand that people put up with this.
Pricing is often higher than what you would pay in other locations for the same thing and sometimes down right ridiculous. I remember seeing what I know as Paracetamol (Tylenol), on a hospital bill for $20. One pill that is – which has a cost price of a few dollar cents. It’s a little known thing that you could bring your own to the hospital to keep that type of cost down in the US.
Until people get critical and start asking questions and go public, this problem is not going to get changed. I dont think the political system has an inherent will to tackle this type of long term problem.
I recall one sadly telling comment from an EU commissioner during the height of the Greek/Euro crisis: “We all know what needs to be done. What none of us know is how to get re-elected after we’ve done it.”
I think your last point “too many apple carts” might be the key issue. While pointing out a symptom it can be fairly easy to talk about the issue. However, when you start digging into the underlying causes things generally get complicated very quickly and can seem to point to an unending series of interconnected problems. So, in todays complex society how do you solve anything or more importantly how to you figure out where to start? You listed several areas where the “rot” is impacting our everyday lives. So how can this be repaired or indeed is the “rot” so wide spread that the “house” is past the point of repair? Don’t want to be the voice of doom but I am not seeing anything that gives me any real hope that changes or repairs are at all likely. It seems all to likely that we are sliding down that slippery slope at an increasing pace.
The USA is the only developed nation to have a for-profit system for basic health insurance. Every other country has figured out a few key things.
The “free-market” doesn’t work when your health or life is on the line. You can’t walk into an emergency room with a heart attack to shop around for hospital with the best price.
A public system places health as the primary priority, not profit. A public system gives the government a measure of control to limit costs on procedures.
Public systems aren’t perfect, but it seems amoral to make a profit off the suffering of others. I’d feel so terrible handing a huge bill to some parent that had just lost their child…
Free market doesn’t work in many areas. Health-care is one of them. Education is another. But people are determined to impose free market principles, metrics and corporate guidelines to both for some reason.
I suspect that any time you have a system where it is meant to be applied equally, not evenly, to all then you cannot allow a ‘free market’ principle to enter into the equation. Be the system public health, welfare in any form or education.