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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Leader: On capitalism and insecurity

The truth behind Philip Green's business practices is out, as Theresa May pledges to ensure the benefits of growth are shared amongst workers.

Although it sounds contradictory, we should count ourselves lucky to read about the hideous business practices at Sports Direct and the management failures that led to the collapse of British Home Stores (BHS). Such stories are hard to investigate and even harder to bring out into the open. That both firms were excoriated by select committees proves that parliament still has teeth.

It is less comforting to wonder why the two retailers were allowed to operate as they did in the first place. Sports Direct pursued “Victorian” working practices, according to Iain Wright, the chair of the committee on business, innovation and skills. The firm is being investigated over allegations that it did not pay the National Minimum Wage, while staff were treated in a “punitive” and “appalling” manner. They were penalised for taking breaks to drink water, and some claimed that they were promised permanent contracts in ­exchange for sexual favours.

Days later, another select committee castigated Sir Philip Green, the former owner of BHS, describing what had happened at the company as the “unacceptable face of capitalism”. The Green family extracted more than £300m from BHS – “systematic plunder”, according to the parliamentary report – even as its pension fund was accumulating a deficit of £571m. Although the committee also criticised Dominic Chappell, who bought BHS a year ago, it concluded: “The ultimate fate of the company was sealed on the day it was sold.”

It would be easy to dismiss Sports Direct and BHS as isolated cases. Yet there is an important connection between them and it is one that illuminates the tides in British politics. Both highlight how economic insecurity has become central to the lives of far too many people in the UK.

Sports Direct treated workers with contempt and left them terrified of losing their employment. The downfall of BHS, meanwhile, cost 11,000 workers their jobs and left its pensioners needing government assistance. Sir Philip Green retains his title, although the shadow chancellor, John McDonnell, has called for it to be rescinded. After all, the committee found “little to support the reputation for retail business acumen for which he received his knighthood”.

In this climate, it is easy to understand the widespread mistrust of private companies. As the business, innovation and skills select committee report concluded: “Although Sports Direct is a particularly bad example of a business that exploits its workers in order to maximise its profits, it is unlikely that it is the only organisation that operates in such a way.”

Anger about the behaviour of companies such as BHS and Sports Direct is rife and was palpable during last month’s referendum on the European Union. In Bolsover, the constituency in which Sports Direct has its main warehouse, 71 per cent of voters opted to leave the EU. Little wonder that voters there did not feel inclined to listen to warnings from the same big businesses that treated them and other people they knew so badly. The company, whose buildings occupied the site of a former coal tip pit, also relied on immigrants who would be less able to insist on employment rights.

Now that the problems have been elucidated so clearly, we must strive to find solutions. As Britain negotiates its exit from the EU, the hard-won labour gains of the 20th century – workers’ rights, provision of state pensions and the minimum wage – must be protected and expanded.

The new Prime Minister, Theresa May, has rightly taken heed of public anger against corporate greed. She has pledged (in statements that could have come from Ed Miliband) to curb irresponsible behaviour and ensure that the benefits of growth are shared. She has supported ideas such as worker representatives on company boards and strengthening the power of shareholders by making their votes on director ­remuneration binding, rather than advisory.

While the Conservatives audaciously try to portray themselves as the “workers’ party”, Labour must campaign hard to ensure that Mrs May backs up her promising rhetoric with meaningful policies. For the good of the nation, business leaders such as Sir Philip Green and Mike Ashley of Sports Direct must be held to account for their actions.

This article first appeared in the 28 July 2016 issue of the New Statesman, Summer Double Issue