America’s health care system is insane. As David Goldhill observed in a 2009 Atlantic piece, asking an insurance company to pay for a routine visit to the doctor is like filing an auto insurance claim every time you fill up. Because they don’t have to worry about out-of-pocket expenses, patients try everything, no matter how much it costs or how remote the chances that it will help. Insurance costs don’t rise because insurance companies are especially greedy. Costs keep rising because of dynamics inherent in the system.

We’ve got the best medical gizmos in the world, but wizardry doesn’t necessarily translate into better care. My father, a general practitioner of the old school, spent hours with his patients, and often found that a long conversation was as therapeutic as medicine. Some were his patients from delivery to death. Today, patients spend less than five minutes each time they visit the man or woman who knows the most intimate details of their physical lives.

And stuffing the federal government between patient and doctor doesn’t help. Since insurance drives up costs, requiring insurance won’t lower them. As Thomas Sowell puts it, “it is amazing that people who think we cannot afford to pay for doctors, hospitals, and medication somehow think that we can afford to pay for doctors, hospitals, medications and a government bureaucracy to administer it.” Amazing, unless you recognize that the government administration’s purpose will be to determine what people really need, which will inevitably be less than what people think they need.

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