Health and Disability

The conservative thesis holds that the demand for health care is unlimited because it has been, historically, a free good for many patients. Moreover, the argument runs, much illness is driven by bad personal health choices — for example, smoking and obesity, and the heart disease and diabetes that follows. Thus, much of our cost problem is actually the patient’s fault.

The “progressive” narrative is more convoluted and absolves the patient of blame. The progressives’ culprit is the way we have traditionally paid for care: fee-for-service payment of doctors and per-admission or per-procedure payment of hospitals. Progressives, and many in the health policy community, believe that cost growth is actually driven by doctors and hospitals seeking higher incomes. The piecework incentive encourages hospitals and doctors to over treat or render care that is completely unnecessary.