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Health care for all, now let's control the costs

This week's Economist magazine (pro-markets, thought Bill Clinton should resign for lying about Monica Lewinsky) gets the historic health bill right. The magazine says:

Now that the United States has joined the civilized world in trying to provide universal medical coverage, maybe it can start concentrating on controlling costs. An OECD study last year showed that the U.S. spent 16 percent of its economic output on health care in 2007, half again as much as the nearest runner-up and nearly twice what the average developed country spends. France, Switzerland and Germany, numbers 2, 3 and 4, were 10 percent or 11 percent.

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There's no financial reason the U.S. can't continue delivering decent care while controlling costs. The trick will be getting the health-care system to change its behavior. The cost "controls" in the health-care bill just passed are "top down" -- basically statements or goals of what aggregate spending will do in coming years. But real change won't come until we work on the "bottom up" details of doing fewer unnecessary procedures and paying doctors to keep patients well instead of to perform tests and surgeries after they get sick.

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