There is more to your point about the cost of health care. Essentially, the answer to your question is all of us. The money for increased national health expenditure comes from our pockets, our taxes, and from lower wages depressed by the cost of insurance.

Once people get that, fundamentally, it's all our money, they have an incentive to invest that money in things that can reduce cost, like preventative care or universal access to evidence-based care.

What we really need is groups like HCAN to be using the message that its all our money. It's not easy, and I'm not sure how you frame it without vilifying those who can't afford insurance. But until start talking about health and health care in this way, we will never see substantial, systemic reform.

Ezra, if you look carefully at the chart, it is actually showing roughly the opposite of what you argue it shows. Or, I should say, that's how it looks if I'm right that the Workers Warnings line reports nominal earnings growth. In which case, we really need to pay attention to the relationship between the Workers Earnings line and the Overall Inflation line. From 1988 to 1995, Overall Inflation is consistently higher than Workers Earnings - this means real wages are falling, even though health care cost growth is decelerating from 1989 to 1996. After that, from 1996 to 2003, the Workers Earnings line is above the Overall Inflation line - meaning that real wages are rising. But at the same time, health care cost growth is accelerating. Real wage growth seems to happen again in 2006-07, when health care cost growth is again decelerating, but I think the overall point is clear. Even though health care cost growth fell from 1989-1995, real wages fell. But despite a rapid increase in health care cost growth from 1996-2003, real wages grew. So in fact this chart at least suggests that real wage growth is largely, if not entirely, independent of health care inflation.

Just for the sake of full perspective I would like to see listed the price of a family health plan that covered all procedures and technologies that were generally available up to 1998, 1988, 1978, etc. -- and then list the procedures and medical instruments no longer available to you for each year you went back -- just to get the true perspective of what we are really talking about here.

Its a case of the availability of every more advanced medical care crowding out other choices: like a newer care or a bigger house. Cannot say, "Don't WANT it; don't pay for it" -- because when you need it we will NOT BE ABLE to refuse it.

@AdamA
One small correction to what you said, preventative care does not generally reduce spending it mostly increases spending.

I don't think the comparison with gas works all that well. Since the 1960s gas has remained gas. It really hasn't gotten any better at moving us around or making our lives better, though it is less polluting now (accounting for some of the cost increase.)

In contrast, health care has changed enormously. Sure, there's a huge amount of waste and ballast. Yes, lifespans have flattened out. But there's more good stuff to buy, whether it's improving cancer therapies or better diagnostic tools, or Lasik surgery for better eyesight, on down the line.

So, yes, health care takes an increasing percentage of income and GDP, and yes, that *has* to be controlled, and yes, there are great models out there how we could achieve the same results at much lower costs. But inefficiently or not, we are getting something for the extra slice of the national wealth we now give for health. When the price of gas goes up, like the cost of land or the cost of the same house over time, we gain no greater value.

So computers are a lot cheaper. Food is (or used to be!) cheaper. Great. That means we can apply our money to other things, like more health care.

When having this discussion about HC Increases consuming wages it is helpful to see the drastic change in out of pocket cost. There is a really good graph out there I can't find anymore but this summerises it;

http://www.ncsl.org/programs/health/forum/FAQ_HealthEconomics.htm

"In 1960, nearly half (48 percent) of the nation’s health care expenditures were financed out of pocket. As noted in figure 2, by 2000 this figure had declined to 15 percent."

Not only has the overall cost of HC skyrocketed but workers are paying a smaller share of it. This is a problem because insurance is a very inefficient method to pay for routine services. If workers accepted higher deductibles and no co-pays the premium savings would more then cover the additional OOP liability. Besides killing off patients HMOs also almost did away with Section 125 Plans. We would all come out further ahead with higher wages and slightly more liberal FSAs. Immediatly reduce the expenses by the 10-20% insurance overhead.

The gas analogy is terrible. If consumers paid for gas like they do healthcare they would only pay $0.60 at the pump and their employer or the government would pick up the rest. A better analogy would be a kid with their parents gas card. It really doesn't matter what gas cost nor how much you drive beecuase your insuslated from the cost. Drive in circles in a huge SUV, if you don't have to pay for the gas it's fun.

It really doesn't matter what gas cost nor how much you drive beecuase your insuslated from the cost.

Bull. Shit.

If gas stations worked like hospitals, there would be no price signs or numbers on the pumps, you'd have to list every other car you've driven and gas station you've used throughout your life, and you'd get billed triple because the attendant thought your car had green paint, then spend two hours explaining to the billing agent that it's metallic blue.

@pseudon..

your post is funny... but it doesnt relate to the 'bull'icity or lack thereof in Nate's post. Just adds flavor to some of the inner details.

so I wasn't the only one that had no idea what pseudonymous in nc was talking about? As far as I can make out I said the analogy between gas prices and HC was terrible and you called BS on me because the analogy was terrible?

Did you see the pic of the pretty trolls below?

I concur that the gas analogy is flawed. If health care were sold like gas:

- gas stations would never post a price
- if you asked for a price you would be told it's private information.
- most people who bought gas would belong to a "club" and get "club" negotiated prices.
- there would be (at a miniumum) three prices: those in a "club" organized around your employer, those in a private "club", retirees in the retired "club", and those not in any "club".
- none of the prices would reflect the actual market price of the gas
- your bill for the gas would include charges for the gas, for the person who did not pump your gas, and for the mechanic working in the shop
- you could not protest your charge for gas unless you got a lawyer

The whole process in the US Is totally broken. I don't see a solution offered by either McCain or Obama that will fix this in my lifetime. Frankly, there are so many special interests that a solution, if one truly exists, may require some catastrophe akin to the great depression to force policy makers to come up with a solution.