More On Healthcare

Feedback and thoughts from Virginia Postrel and readers.

Like any patient, I have many complaints about the current system. I, too, have wasted time convincing my insurer to pay bills for procedures obviously covered under my plan. I, too, have been bewildered trying to reconcile the strangely different ways in which medical center billing departments and the insurer classify exactly the same expenditures. And, of course, as a patient with a pre-existing condition who has in the past been happily self-employed, I am acutely conscious that my own options are now more limited than they once were.

Before my personal experience as a patient, I objected to the delivery of health insurance through employers, as many economists and policy analysts do. Employer-based health insurance unduly limits the flexibility of Americans to change jobs, work part time, or start businesses and amplifies the negative repercussions of an economic downturn like the one we’re now experiencing. I also know that the current system of reimbursement, led by Medicare, has taken a terrible toll on primary-care physicians in particular, driving many out of medicine and requiring others to skimp on care (spending little time with patients) or develop cosmetic side-specialties (Botox, anyone?) to subsidize their practices.

But acknowledging that the current system has problems and might be improved is a long way from believing that those problems can be solved simply—or that Americans can have, as many readers seem to believe, health care that is simultaneously cheaper, less likely to escalate in cost, more widely available, technologically innovative, and fully responsive to the desires of patients and physicians.