n his “The Naked Economist” column, Charles Wheelen poses the fundamental question, “Why do we need a health care system, and what should be it’s guiding principles?”

He says:

Health care is different from all other basic needs because the costs are so unpredictable. The bill for your health care next year could be $150 or it could be $3 million. That’s true no matter how healthy you feel right now.  And that’s not true with food or housing.

So, if you were thinking about a health system that would help us share those costs, he says you would do two things:

1. You would encourage good health.
2. You would only spend the group’s money on cost-effective medical care.

And then concludes:

How does our current system do in this regard?  Miserably. We are unable to have a conversation about spending health care dollars in a cost effective way before talk show hosts begin screaming about death panels.

Instead, we say “yes” to just about everything medically possible for those lucky enough to have some kind of insurance. Then we sit around and complain about how much our health care system costs.

So here is the second no-brainer for health care reform: If we want to restrain the current unsustainable growth in health care spending, then we will have to say “no” to those things that make the least medical sense.

We have a health care club in the United States, or more accurately, many of them.  For the most part, our rules are outdated.  Health care reform will require a thoughtful discussion of who gets into our club and how generous we want to be with our members, recognizing that each of us is both a bill payer and a prospective patient.

Until we resolve that, everything else is just noise.

Read the whole article here.