Niraj Chokski points to historical trends in the cost of eduction:

For 27 of the past 30 years, the price of education has grown at a faster rate than that of medical care. Education also grew faster than inflation for 29 of the past 30 years, while medical care beat inflation 27 of those years.

It is easy to imagine that increase in demand is the primary driver of this trend.  It will be interesting to see how this plays out for individual schools. How will the expenditures they incurred based on the need to compete in a crowded education market (new dorms, trendy dining facilities, improved athletic facilities etc.) effect their ability to compete in a changing market.

Another post from a reader at the Daily Dish/Andrew Sullivan in the View from Your Sickbed series. This time a mother writes of the choices her family was forced to make because they had chosen to switch from  private, self-employment insurance to Blue Cross:

Let me state that very clearly one more time: we almost didn’t take our baby girl, who was in severe respiratory distress, to the doctor because we knew that it would hurt her chances of getting insurance.

Dan Roam of Back of the Napkin has developed an interesting slideshow clarifying what is going on in the health care debate, and the reason for reform. Check out all 4 napkins:

Napkin #1: The health care
equation.
Napkin #2: It’s not about
health care.
Napkin #3: The plans on
the table.
Napkin #4: What’s it mean
to me?

Andrew Sullivan has been running a series over at The Daily Dish called The View From Your Sickbed where people email personal perspectives on healthcare reform. Today’s post focused on one readers personal experience with Healthcare Savings Accounts:

I’ve noticed that those who rave about [Healthercare Savings Accounts] are usually doing so from a theoretical perspective, not from personal experience as a consumer. As a freelancer, I’ve had an HSA for several years, and I hate it.

The policy has a $3500 deductible, so, short of a catastrophic claim, I pay for everything out-of-pocket. It’s true that I only pay $113/mth in premiums for my insurance policy, but I never actually use my insurance policy (other than receiving the insurer’s negotiated rates for medical services), and it really comes out to $405/mth if you include the deductible that I must pay before getting coverage ($3500/12=$292, although I’m only allowed to deposit $2,900 in the HSA annually).

Yes, the deductible is paid with “pre-tax” dollars (I still pay state and self-employment taxes on any deposits to my HSA), but that doesn’t make it any less painful when I’m paying the bills. And it definitely deters me from seeking care on a timely basis. In the past year, I’ve had two different doctors suggest an MRI (which they seem to do as a matter of form these days–and usually at an affiliated MRI center that shares profits with the doctors). I still haven’t gotten an MRI because, with business down significantly, I can’t afford at least $1,000 for a test that may well prove inconclusive.

I’ve found no medical providers willing to negotiate with me for their services. In fact, many of them seem almost totally unfamiliar with HSAs and how they work. And what patient really wants to try to negotiate lower prices with a provider? Talk about uneven bargaining positions. That’s just another conservative “let-the-marketplace-decide” pipe dream that is totally removed from reality.

I’m also deterred from seeking timely care because I don’t want to make myself uninsurable in the future. Last year, I applied for a group policy through my alumni association. After I completed the detailed application and provided additional information over the phone, I received a letter telling me Blue Cross California was “declining” my coverage. Days later, I received another letter listing three reasons:
* Knee tendonitis and low arches treated with physical therapy (in 2002)
* Shin splints treated with physical therapy within the past year (which
cost me $3,000 out of pocket)
* History of treatment for sciatica (once-in 2004)

My blood pressure, heart rate, and cholesterol are all low, and I weigh less now than I did 20 years ago in college. I take no prescription drugs, have never been seriously ill, and have never received ominous test results. But I couldn’t get group coverage because I’d previously sought medical care while insured under COBRA or grad school policies. And a traditional individual policy would be prohibitively expensive. This is how we encourage people to become entrepreneurs?

Our system is clearly in need of reform.

The idea of making oneself uninsurable is particularly on point, and should be included  in the “rationing” of healthcare discussion.

Some of the other posts from the series worth reading:

• Newborn Son Has a Preexisting Condition
• Fear Emergency Services Will Bankrupt You (Similar story)
• Non-transparency of Health Care Costs
• Surgeon: No One Recognizes the Savings, Or Even Cares
• Complexities of Medical Billing
• $10,000 ER Visit
• Chronic Illness Would Drive Up Employer Premiums

Or, if you have the time, read them all!

“A recession (or depression) ends when GDP returns to (or near) its trend line.”

Richard Posner,  with the  clearest answer I have heard on the subject.