A great deal of the critique of health reform from the right boils down to something like this: Health Care is like ice cream, if you make it free then people will consume huge amounts of health care,wasting valuable resources. The all purpose solution to this "problem" is to raise prices that consumers pay for health care which should lead them to consume less and thus lower the costs for everyone.

No one, not even conservatives, likes to think that they live in a society that allows people to die without care so even conservatives will make some exceptions. They would, for example, like to encourage everyone to buy low cost, high deductible plans that will pay for medical treatment, but only in the event of a major life threatening episode.

They also seem to approve of the current EMTALA legislation that forces hospitals that run emergency rooms and doctors who work in these emergency rooms to provide care to anyone who shows up with a life threatening condition.

Furthermore, our current health policy lets people fend for themselves from birth to age 67 or the onset of some disability. After this event they get fairly generous health care coverage.

All of these policy choices have an impact on incentives. A growing number of consumers face high prices for initial or ordinary care, something like $75 to $100 per doctor visit plus medications. Those who have insurance will eventually meet the deductible and get free care but only after significant out of pocket expenses. The consumer will try to save money by avoiding treatment until the discomfort of untreated problems becomes great enough to drive him or her to the Emergency Room.

Of course at this point the consumers condition will have deteriorated. Flu will be followed by bacterial infection which will be followed by pneumonia. A condition that would have initially required antibiotics will now demand a hospital stay. But, where the cheaper treatment would have cost the consumer a great deal, the increasingly complex and expensive treatment will cost the consumer little or nothing. The deductible will be met on the first day in the hospital and everything else will be free. And if the consumer is disabled by the illness - say they get kidney failure as a result of untreated diabetes - they will get free, expensive care for the rest of their lives.

The way things are currently set up we charge consumers high prices for timely, socially inexpensive, medical care while they are young and well. In other words while such medical care can have an impact on their lives and overall health. When the consumer gets really sick, when it is too late to make a difference in their health and the cost of their treatment, we pay for everything.

Is it any wonder that our health care spending is so high?