Fundamentally, every cost you want to wring out of the system is someone else’s income, or perhaps, their only hope of escaping a dreadful disease. Often, those someones make very sympathetic figures when they appear on your local telecast, weepily complaining that the government is killing patients. This political reality made it hard for either the government or private insurers to actually reduce what they spend on our health care.
Moreover — and this is the important bit — we aren’t the only country that has this problem. Look abroad and you’ll realize almost no developed country has ever managed a sustained reduction in its health-care spending — though Greece had a debt crisis that forced the government to dramatically slash what it was spending on almost everything. Many countries restrained the rate of growth better than we did, but, eventually, we developed some discipline, and our health-care costs are no longer growing particularly fast, compared with others.
Unfortunately, we’re still stuck at a high level, thanks to our earlier profligacy. And politically, it has seemed that the only way to muster the will to actually cut the level of health-care spending, rather than restraining its future growth, would be to run out of money, so that international lenders, rather than politicians, would end up controlling what the government could spend.
Then along came the pandemic, and it turns out there’s another way, which is to have your country ravaged by a deadly infectious disease. That is definitely not what I would have predicted in March.
There are a few observations that can be drawn from this. The first, and most obvious, is that despite its terrible costs, this pandemic has not been as bad as many historical plagues; I doubt our spending would have dropped if we’d been dealing with the Black Death. This is exceedingly small comfort, but I’m ready to count even tiny blessings.
The second is that the decline is presumably a result of deferred care, and therefore temporary. When people are vaccinated, and caseloads fall, they’ll probably start going back to the doctor as much as they ever did. And possibly more, if deferring care has caused their medical conditions to spiral into much larger problems that are more expensive to treat.
But note, I said “if.” We’ve never before run an experiment where a huge number of Americans just stop going to the doctor for a year. We don’t know exactly what sort of care they’ve put off, or how much that matters. And it is at least possible that we’ll find out that some of those routine medical visits just didn’t help as much as is generally assumed.
Even before the pandemic, there was, for example, a lively debate over early cancer screening, because while it might be helping us catch a lot of cancers when they’re more treatable, it might also be fooling us into thinking our screenings and treatments work better than they do, since people whose cancer is caught earlier will “survive cancer” longer even if the treatment does nothing at all.
We might also find that though delaying care harmed people, boosting innovations like telemedicine offset those harms. I can’t say I think that’s the most likely outcome, but I won’t rule it out without more data.
Which brings me to my final observation: The universe is damn complicated, and even our seemingly most obvious and indisputable guesses at the future will often be unraveled by effects we failed to foresee. Yes, I might have predicted toilet paper shortages in the early days of a pandemic, but if you’d asked me about health-care costs and house prices, I would have said the former would go up and the latter down — the exact opposite of what has happened.
We should always leave room for a fair amount of surprise in our mental models of the world. Now that I know bothpandemics and currency crises can reduce health-care spending, I suppose I’ll have to leave room for the possibility that there are other ways I haven’t guessed, hopefully less awful, and more amenable to reason.