Why health reform is going to be difficult, and the trouble with saying no to American patients

How do we control health spending?

Most strategies boil down to eventually restricting care, for instance, not paying for treatments that haven’t been shown to work on a macroeconomic level. That may make sense when you’re talking numbers and statistics, but there will be real lives at stake when reform takes hold.

Economist Arnold Kling understands what must be done, but imagines a scenario where his daughter hypothetically was diagnosed with cancer.

“Imagine that the best hope is a treatment that costs $100,000 and offers a chance of success of 1 in 200,” writes Mr. Kling. “Would I want her to get that treatment? Absolutely.

But look at the issue from a rational, bureaucratic perspective. You have to treat 200 patients at a cost of $100,000 each in order to save one life, for a cost per life saved of $20 million. Is that what a rational bureaucracy would do?

A rational bureaucracy would not even tell the family about this treatment option. But I think that in the American culture regarding medicine, I would find out about it.”


American medicine has been used to offering the latest and the best to patients for a long time. With this mentality, where very few treatment options and diagnostic tests have historically been denied, it will be very difficult for both doctors and patients to accept access to every conceivable health care option being restricted in any way.