Our system doesn’t allow Medicare to strike those sorts of bargains. On the health side, if Medicare doesn’t pay enough, doctors can opt out of the program. On the political side, legislators are reluctant to impose deep shop online 2011cuts on their good friends and campaign contributors in the medical industry. When Congress passed the Medicare Prescription Drug Benefit in 2003, for instance, it explicitly prohibited Medicare from bargaining for better prices on drugs. The Ryan Plan Another option is to price people out of care. This is essentially the solution proposed by Representative Paul Ryan of Wisconsin. The Congressional Budget Office estimates that if Ryan’s plan is enacted, in 20 years seniors will pay an average of 70 percent of their insurance costs,compared with about 30 percent under the current system. But Ryan’s plan appears dead. Health-care costs prove his point perfectly. Few policy problems are more confounding than the inexorable rise in health-care spending. It threatens the economy even as the health-care system fails at its basic power balance task of making us healthier. But the only way to fix it runs counter to both our instincts and our political system: we need to allow ourselves to fail -- often, enthusiastically and, above all, constructively. When you hear the words "health-care costs," it’s good to apply a quick mental auto-correct. What people really mean are "sick-person costs." When five percent of patients account for 50 percent of spending, you’re not talking about the costs that most Americans with health-care insurance rack up over the course of a year. You’re talking about the costs racked up by a tiny fraction who suffer from serious health conditions. Overpaying for Care If you travel internationally, you’ll see that other countries have come up with fairly simple ways to keep those costs down. One option, which every other developed nation employs, is to simply use the blunt force of government purchasing power to set low prices. That’s how you get American seniors heading to Canada to purchase American-made pharmaceuticals at a steep discount. Wal-Mart has nothing on those guys. But it’s not just the Canadians. And it’s not just drug costs. A 2007 McKinsey & Co. Inc. study surveyed a range of health-care delivery systems and concluded, after making adjustments for purchasing power, that we were overpaying for health-care services and products to the tune of $500 billion a year. That’s about 20 percent of our total annual health-care spending. Tim Harford has an unusual fear about government failure. He’s not worried that the government fails too often. He’s worried that it doesn’t fail often enough. The British economist is the author of the compelling new book,"Adapt: Why Success Always Starts With Failure." In it, he warns that "we face a difficult challenge.The more complex and elusive our problems are,the more effective power balance trial and error" -- which is to say, failing and learning from those failures -- "becomes, relative to the alternatives. Yet it is an approach that runs counter to our instincts, and to the way in which traditional organizations work."
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