Is healthcare spending doomed to increase forever?

Does healthcare spending suffer from an inevitable escalation in costs? Can it ever be reduced?

Matt Yglesias has a good post up over at Slate, detailing the problem that all wealthy countries have when it comes to healthcare expenditure: Demand for health is, quite literally, insatiable.

Yglesias writes:

It turns out that electronic medical records may not reduce health care spending (see Lohr & Kliff) for the very sensible reason that when you make it cheaper and easier to order and analyze tests, medical professionals grow more inclined to order tests. It's kind of a health care version of the energy efficiency rebound effect, when you make it cheaper to keep your home comfortably warm in the winter people grow more inclined to crank up the heat rather than wear a thick sweater inside. The difference is that once you reach a certain level of affluence your house is warm enough and you find yourself sated. The crux of the matter with healthcare is that we're never really sated. Once you're talking about a middle class family in a developed country—a family that's not worried about starving to death or freezing on the streets or being unable to afford shoes—you're talking about a family that's going to plow what resources it has into attempting to address the potentially limitless health care needs of its members.

It is a real concern for anyone trying to improve the efficiency of health services; and yet, at the back of my mind, I couldn't get this out of my head:

Healthcare: Chart One

It clearly is possible for the US to reduce spending on health - possibly even halve it. So what's missing from Yglesias' analysis? It may be as simple as saying 'no'.

For all the hysteria over the accusation that Obamacare would lead to a network of "death panels", the problem with the claim is more style over substance. Health systems necessarily involve an element of rationing (we do not live in a post-scarcity society quite yet); but whereas NICE attempts to do that in a way that guarantees the most efficient use of resources for the nation as a whole, the US system follows the path which ensures that those who can afford to spend ever-increasing amounts of money, to secure ever-decreasing returns, do so.

In the long term, we may hope for a change in attitude to that demonstrated in Ken Murray's wonderful piece from January, but for now, it seems that the best response to the infinite demand for health may be gentle pressure in the opposite direction.

A patient is monitored by a nurse while walking on crutches. Credit: Getty

Alex Hern is a technology reporter for the Guardian. He was formerly staff writer at the New Statesman. You should follow Alex on Twitter.

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I dined behind the Houses of Parliament in my sexually connected foursome

My wife and I would sometimes dine out with another couple. We did not always check the significance of the date. 

I am self-employed and find that working from home, setting your own schedule, the days generally blur into each other, with weekends holding no significance, and public holidays, when those who are employed in factories, offices or shops get time off, meaning nothing. I am often surprised to go out and find the streets empty of traffic because it is some national day of observance, such as Christmas, that I wasn’t aware of. I find myself puzzled as to why the shops are suddenly full of Easter eggs or pancake batter.

Growing up in a Communist household, we had a distinct dislike for this kind of manufactured marketing opportunity anyway. I remember the time my mother tried to make me feel guilty because I’d done nothing for her on Mother’s Day and I pointed out that it was she who had told me that Mother’s Day was a cynical creation of the greetings card monopolies and the floral industrial complex.

Valentine’s Day is one of those I never see coming. It’s the one day of the year when even the worst restaurants are completely booked out by couples attempting to enjoy a romantic evening. Even those old-fashioned cafés you’ll find still lurking behind railway stations and serving spaghetti with bread and butter will tell you there’s a waiting list if you leave it late to reserve a table.

In the late 1980s my wife and I would sometimes dine out with another couple, he a writer and she a TV producer. One particular place we liked was a restaurant attached to a 1930s block of flats, near the Houses of Parliament, where the endless corridors were lined with blank doors, behind which you sensed awful things happened. The steel dining room dotted with potted palm trees overlooked a swimming pool, and this seemed terribly sophisticated to us even if it meant all your overpriced food had a vague taste of chlorine.

The four of us booked to eat there on 14 February, not realising the significance of the date. We found at every other table there was a single couple, either staring adoringly into each other’s eyes or squabbling.

As we sat down I noticed we were getting strange looks from our fellow diners. Some were sort of knowing, prompting smiles and winks; others seemed more outraged. The staff, too, were either simpering or frosty. After a while we realised what was going on: it was Valentine’s Day! All the other customers had assumed that we were a sexually connected foursome who had decided to celebrate our innovative relationship by having dinner together on this special date.

For the four of us, the smirking attention set up a strange dynamic: after that night it always felt like we were saying something seedy to each other. “Do you want to get together on Sunday?” I’d say to one of them on the phone, and then find myself blushing. “I’ll see if we can fit it in,” they’d reply, and we would both giggle nervously.

Things became increasingly awkward between us, until in the end we stopped seeing them completely. 

This article first appeared in the 25 May 2017 issue of the New Statesman, Why Islamic State targets Britain

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