Why are our health costs so high? In part, because people spend large amounts of money on futile care - care for someone who has no chance of recovering, or only a very small chance. (For example, when someone is told they only have a few weeks to live and that there is essentially zero chance of recovery. There COULD be a miracle, though.)
It usually makes emotional and spiritual sense for individual people to make that spending decision. The emotional cost of not doing so would be far higher than the fiscal cost of going to the limit. However, this is not a policy that we can put in place for everyone, because the emotional calculus is different. I will mortgage my future and sell my soul to gamble on keeping my baby alive; I will not do so to gamble on an abstract group of strangers. Neither will anyone else; although levels of altruism will vary, and some people will cut deeper than others for strangers’ welfare, few-approaching-none will make the sacrifices for strangers that they will make for kin.
From a humanitarian point of view, then, it seems logical for decisions about such extreme measures to be left in the hands of individuals. Resources being equal, more sacrifices will be made and more care will be provided in desperate cases when decisions are made closest to the patient. This is undoubtedly a major component of why our health care costs are systemically higher than those of nations with single-payer or nationalized health care; Britain’s NHS isn’t spending a million dollars trying to keep Grandma alive, but in the US, Grandma’s kids are.
At the other level of care, I think the decision calculus might actually work the other way. Some individuals show a reluctance to rationally budget for preventative and maintenance-type healthcare; members of a more distant group, aware that they have a good chance of being stuck with the eventual enormous bill when Joe keeps skipping the physical exams (”that shooting pain in my left arm will go away if I just have another beer”), are probably more willing to pay for Joe’s doctor visit than Joe is.
On that humanitarian basis, I’d probably be more receptive to a public health policy that supported preventative and maintenance-type care, and left big-ticket items up to individuals to deal with.
