Disappointed, who writes from France where he is likely covered by fairly comprehensive, highly regulated health insurance, thinks that the high cost of medicine in these United States is caused by comprehensive health insurance.

. . .these generous policies encourage over-use of health care services (the other, sometimes unstated, argument is the need to raise money to pay for the bill). Consistent with this logic, it seems that higher the deductibles and co-pays, the lower the consumption of unnecessary services. The theory here, which few economists dispute, is that if a consumer has skin in the game, he or she will be more circumspect about costs that he or she incurs. A better analogy is the « all-you-can-eat » buffet. Casual observation confirms that one tends to eat more at these establishments than at a la carte restaurants (the quality of the latter also tends to be higher, in my experience). A second factor is that with generous policies, under which all the costs are paid by third parties, the consumer is not only financially isolated from cost, he or she is also blithely ignorant of it. This is not a recipe for weight reduction, much less healthcare cost containment. Yet another buffet phenomenon is that buffet customers not only tend to eat more, they also try to feed off the choicest buffet selections. In the realm of healthcare, this means costly brand drugs rather than generics.

Because health care is just like an all you can eat buffet. Except the the best of the dishes that you can put on your plate have all the flavor of warm library paste and most other are painful to eat and produce various unpleasant side effects - nausea, impotence and incontinence to name a few.

And the consumer, who knows virtually nothing about the dishes relies on the advice of this guy who goes through the buffet with him. The adviser eats nothing, suffers from none of the unpleasant side effects and just happens to get paid a significant percentage of the cost of all the dishes that the consumer chooses.

Other than that it is just like all you can eat night at your local Chinese restaurant and if we force consumers to pay for large chunks of their medical care then market magic will be free to do its work and we will experience a revolution in health care.

Or maybe sick people will just pay more and the healthy will enjoy low health costs until they get sick.

In a field, like economics, that depends on analogy a shallow thoughtless analogy can do great damage. The real problem here is the way that we pay our health advisers - that would be doctors. As long as doctors are rewarded for providing more health services instead of better health the pressure to increase services offered will exist and we will have cost problems.

High Deductible plans leave all of the fee for service apparatus intact and force all medical transaction - up to about $6,000 per person - into the fee for service marketplace. Only after the consumer gets really sick do we get to the Accountable Care world. By then it is too late.