The dream of universal health care is haunted by the reality of aging
A Law Of Diminishing Returns applies to every additional year of life that the population gains
This is an iron law of the human life cycle: the Law Of Diminishing Returns applies to extending human life.
I have many progressive friends who ask "Britain created the NHS in 1948, and since then they've had universal health care. Why can't the USA have what Britain had back in 1948?"
In truth, you can, this is cheap and easy to do, so long as you are willing to accept an average age of death of 68, which is what Britain accepted in 1948. See charts.
The average life span in Britain is now 82 years. It's the extra 14 years of life that are expensive. And the Law Of Diminishing Returns means that each additional year, going forward, will be much more expensive than the previous.
Once upon a time, people would get high blood pressure, then they would die. Nowadays, people get high blood pressure, then they go on living for another 40 years, taking an increasingly expensive cocktail of drugs to manage that high blood pressure.
Linosopril. Labetalol. Metoprolol. Amlodipine. They all cost money.
The same is true for every other illness you can think of: cancer, Parkinson's, heart disease. We are getting better and better at extending life. But the cost keeps going up.
The issue is not just the expensive drugs, the more fundamental issue is the growing specialization of doctors, necessary to implement increasingly sophisticated medical treatments. The specialists are expensive and rare, yet they are totally necessary if we want to live in a world where it seems normal for average life spans to last into people's 80s.
It is true that the system of private of insurance, that we have in the USA, is uniquely wasteful, and we could save some money if we got rid of it and switched to a different system.
But it is also true that national health care systems are under strain everywhere: Canada, Britain, and much of Europe.
This is an issue that needs to be addressed: is there any limit to how far down this Law Of Diminishing Returns we wish to go?
Young progressives in the USA are hoping that the USA can simply imitate the social democracies of Europe. Perhaps they have not noticed how much social democracy in Europe is under strain. The problem is no longer merely a matter of political will. Even if Bernie Sanders was President and every person in Congress was a clone of AOC we would still face many problems implementing universal healthcare.
Among the many problems we face: how can we best combine the skills of diverse specialists? Anyone who has ever had a complicated and ambiguous health situation is aware how maddening and complicated the current system is. You might go to one specialist and they check you and determine that, whatever problem you have, it is not their specialty. So you go to another specialist, and after several tests, they determine that, whatever your problem is, it is not their speciality. You might have to do this dance 4 or 5 times before you get a diagnosis for your problem. Is there a a better way?
It is true that the USA is doing worse than other nation. Our system of private health insurance leads to a shocking amount of redundant bureaucracy, and little accountability when it comes to controlling costs. At least since 1980 our costs have risen more quickly than what’s been seen in other developed nations. According to the Centers for Medicare and Medicaid Spending: “U.S. health care spending grew 4.1 percent in 2022, reaching $4.5 trillion or $13,493 per person. As a share of the nation's Gross Domestic Product, health spending accounted for 17.3 percent.”
You can note two things in this chart:
The USA is doing worse than other countries.
Every nation is seeing an upward trend, as their populations get older.
In the end, anyone who wants to see universal healthcare survive, in the USA or in Europe, is going to have to get fanatic about controlling costs in a hospital setting. This will probably mean cutting down the bureaucracy as much as possible, limiting investments in technology, and looking for the simplest mechanisms of accountability, which might be peer review. In the USA, there is also the problem of medical lawsuits, which will have to stop.
But even after we do all that, we will need innovative breakthroughs in the field of Organizational Theory, to help us better combine groups of specialists together. By the next decade, this will be the most urgent problem we face.