Even though the vast majority of the people involved in the US medical care system experience the stupidity and ineffectiveness of many aspects of the system, it helps to remember that the people who control the system benefit from it as it is now. Every cost you want to cut or efficiency you want to implement is seen by someone in the system as their bread and butter, or their end-of-year profit. If we talk about reducing the total cost of medical care in the US by 50% so that it corresponds more closely with costs in other developed countries, where the outcomes are as good or better than in the US, that is still moving some 8% of US GDP away from the people that it now keeps employed. Could they be more effectively employed elsewhere? Clearly, but vested interests are not interested in changing what works for them, and the rest of us have neither the expertise nor the urgency to force the change.
In a 1993 essay published online in the Hoover Institution's website Milton Friedman shrewdly noted how government intervention in the economy often confers unintended benefit on relatively few parties with special interests to the detriment of everyone else and why such counter-majority boondoggles are so prevalent and so persistent. https://www.hoover.org/sites/default/files/uploads/documents/friedman-government-problem-1993.pdf
Here's an excerpt:
"Government actions often provide substantial benefits to a few while imposing small costs on many. .... [T]alking to a taxicab driver in New York City ... I asked him the market price of a medallion to drive a taxicab. As you know, the number of taxicabs is limited by government fiat. The medallion signifying permission to operate a taxicab is transferable and traded in a relatively free market. Its current price is apparently now somewhere between $100,000 and $125,000.
"If the limitation on the number of taxis were removed, the benefits would greatly exceed the
losses. Consumers would benefit by having a wider range of alternatives. The number of cabs
would go up and so would the demand for drivers. To attract more drivers, the earnings of
drivers would have to rise. In economic jargon, the supply curve of drivers is positively
sloped.
"Why does the limitation of the number of cabs persist? The answer is obvious: the people
who now own those medallions would lose [if the limit were ditched] and they know it. Although they are few, they would make a lot of noise at city hall. The people who would end up driving the additional cabs do not know that they would have new jobs or better jobs. There is no New Yorker who would find it worth his or her time and effort to lobby city hall to remove the arbitrary limitation on medallions simply to get better cab service. It does not pay the individual taxi riders to do so. They are right; it is rational ignorance on their part not to do so.
"The phenomenon of concentrated benefits and dispersed costs is a valid explanation for many governmental programs. However ... it does not explain why, once a government enterprise is established, it should be so much less efficient than a comparable private enterprise. [W]hy ... should the U.S. Post Office be less efficient than United Parcel Service?
.... The people who run our private enterprises have the same incentive as the people who are
involved in our government enterprises. In all cases the incentive is the same: to promote
their own interest. ....
"[But] self-interest is served by different actions in the private sphere than in the
public sphere. The bottom line is different. [If] an enterprise started by a group of people in the
private sphere ... fails, it loses money. The people who own it have a clear bottom line. To keep it going, they have to dig into their own pockets. They are reluctant to do that, so they have a strong incentive either to make the enterprise work or to shut it down.
"Suppose the same group of people start the same enterprise in the government sector and the initial results are the same. It is a failure .... They have a very different bottom line. .... [T]hey have a much different and deeper pocket to draw on. With the best intentions in the world, they can try to persuade the people who hold the purse strings to finance the enterprise on a larger scale, to dig deeper into the pockets of the taxpayers to keep the enterprise going. That illustrates a general rule: If a private enterprise is a failure, it closes down—unless it can get a government subsidy to keep it going; if a government enterprise
fails, it is expanded. ....
"The general rule is that government undertakes an activity that seems desirable at the time.
Once the activity begins, whether it proves desirable or not, people in both the government
and the private sector acquire a vested interest in it. If the initial reason for undertaking the
activity disappears, they have a strong incentive to find another justification for its continued
Even though the vast majority of the people involved in the US medical care system experience the stupidity and ineffectiveness of many aspects of the system, it helps to remember that the people who control the system benefit from it as it is now. Every cost you want to cut or efficiency you want to implement is seen by someone in the system as their bread and butter, or their end-of-year profit. If we talk about reducing the total cost of medical care in the US by 50% so that it corresponds more closely with costs in other developed countries, where the outcomes are as good or better than in the US, that is still moving some 8% of US GDP away from the people that it now keeps employed. Could they be more effectively employed elsewhere? Clearly, but vested interests are not interested in changing what works for them, and the rest of us have neither the expertise nor the urgency to force the change.
In a 1993 essay published online in the Hoover Institution's website Milton Friedman shrewdly noted how government intervention in the economy often confers unintended benefit on relatively few parties with special interests to the detriment of everyone else and why such counter-majority boondoggles are so prevalent and so persistent. https://www.hoover.org/sites/default/files/uploads/documents/friedman-government-problem-1993.pdf
Here's an excerpt:
"Government actions often provide substantial benefits to a few while imposing small costs on many. .... [T]alking to a taxicab driver in New York City ... I asked him the market price of a medallion to drive a taxicab. As you know, the number of taxicabs is limited by government fiat. The medallion signifying permission to operate a taxicab is transferable and traded in a relatively free market. Its current price is apparently now somewhere between $100,000 and $125,000.
"If the limitation on the number of taxis were removed, the benefits would greatly exceed the
losses. Consumers would benefit by having a wider range of alternatives. The number of cabs
would go up and so would the demand for drivers. To attract more drivers, the earnings of
drivers would have to rise. In economic jargon, the supply curve of drivers is positively
sloped.
"Why does the limitation of the number of cabs persist? The answer is obvious: the people
who now own those medallions would lose [if the limit were ditched] and they know it. Although they are few, they would make a lot of noise at city hall. The people who would end up driving the additional cabs do not know that they would have new jobs or better jobs. There is no New Yorker who would find it worth his or her time and effort to lobby city hall to remove the arbitrary limitation on medallions simply to get better cab service. It does not pay the individual taxi riders to do so. They are right; it is rational ignorance on their part not to do so.
"The phenomenon of concentrated benefits and dispersed costs is a valid explanation for many governmental programs. However ... it does not explain why, once a government enterprise is established, it should be so much less efficient than a comparable private enterprise. [W]hy ... should the U.S. Post Office be less efficient than United Parcel Service?
.... The people who run our private enterprises have the same incentive as the people who are
involved in our government enterprises. In all cases the incentive is the same: to promote
their own interest. ....
"[But] self-interest is served by different actions in the private sphere than in the
public sphere. The bottom line is different. [If] an enterprise started by a group of people in the
private sphere ... fails, it loses money. The people who own it have a clear bottom line. To keep it going, they have to dig into their own pockets. They are reluctant to do that, so they have a strong incentive either to make the enterprise work or to shut it down.
"Suppose the same group of people start the same enterprise in the government sector and the initial results are the same. It is a failure .... They have a very different bottom line. .... [T]hey have a much different and deeper pocket to draw on. With the best intentions in the world, they can try to persuade the people who hold the purse strings to finance the enterprise on a larger scale, to dig deeper into the pockets of the taxpayers to keep the enterprise going. That illustrates a general rule: If a private enterprise is a failure, it closes down—unless it can get a government subsidy to keep it going; if a government enterprise
fails, it is expanded. ....
"The general rule is that government undertakes an activity that seems desirable at the time.
Once the activity begins, whether it proves desirable or not, people in both the government
and the private sector acquire a vested interest in it. If the initial reason for undertaking the
activity disappears, they have a strong incentive to find another justification for its continued
existence." [goes on to give further examples]
Evidently I'm not psychologically normal. Should I seek help?