So John McCain has been taking jabs at Barack Obama for suggesting that all employers should be forced to carry health insurance for all employees. In response, Obama's camp has come out with a new detail: A tax credit of up to 50% of the premiums for all small businesses that carry health insurance.
The whole discussion is buoyed on oceans of unquestioned assumptions and questionable logic. But right now, I want to focus on the biggest question that no candidate dare ask about health care policy: Why does it cost so much? Why, year after year, do we pay in the neighborhood of 50% more per capita than, for instance, Switzerland and Norway, nearly twice as much as Germany, France, or Canada, and more than twice as much as Sweden – and get worse results?
Why is our healthcare inflation rate consistently two to three times the general inflation rate? In 2006, the general basket of goods and services behind the Consumer Price Index would have cost you five times what it would have cost you in 1970 – while in the same period "national health expenditures per capita" had increased 20 times. Why do private health care premium increases consistently outpace the rise in actual health expenditures, in some recent years doubling the rate?
Do these facts have anything to do with the large and obvious differences between our system and the others in the world, such as our large, profitable, and relatively unfettered private health plan sector, through which more than one third of all our health care expenditures are channeled? Or the lack of feedback mechanisms in the system, whether market-generated or regulatory, to channel healthcare resources to what is effective and efficient, rather than to what helps the bottom line of the individual institutions, the companies, and the practitioners in the system?
The candidates can't ask those questions because, if we asked them seriously, the answers would upset too many apple carts. And the traditional answers (We have more choice. Really? We have the best healthcare in the world. Really?) are increasingly wearing thin, even for the average voter.