Imagine that, toward the end of a long, fulfilling life, you are diagnosed with terminal cancer. You can flip through a calendar and point to pages that will fall after the coldness of mortality has become your reality. Treatment can give you another half of a year – for $5,000 a month. Would you spend the money? There are some who would be willing to pay any price to forestall the inevitable. Others would rather take a final vacation or leave the money to their family members. This decision is as personal as decisions can be, and it shouldn’t be up to me – or anybody else – to decide. But we don’t live in a world where rights are respected. At present, only the uninsured have the undesirable responsibility of choosing between the difficult tradeoffs of health care. When the majority of Americans face health care payments, they pay a small out-of-pocket fee, and their health insurance covers the treatment with little questions asked. In 2008, consumers only directly paid for 11.9 percent of health care expenditures, according to the U.S. Department of Health and Human Services. In 1965, that number was 43 percent. When prices fall to zero, demand increases. Many who would otherwise go without medical treatments find themselves in the waiting room. Health insurance premiums rise, take-home pay decreases and those on the margins are left without coverage. Our health care system is bloated by waste, and turning to the witch-hunt of preventative care won’t save us. The U.S. Preventive Services Task Force, an independent panel of experts appointed by HHS, found insufficient evidence to recommend prostate cancer screening in men younger than 75. The American Cancer Society does not recommend routine screening for prostate cancer. The same group only recommends breast cancer screening for women ages 50 to 74 and recommended against teaching breast self-examinations. In other words, millions of Americans have their insurance providers pay doctors to squeeze their breasts and finger their prostate for no medical reason. Many studies show our medical system is plagued by waste. The most extensive is the RAND Health Insurance Experiment. Since 1971, 5,809 individuals were randomly assigned to insurance plans with varying levels of cost sharing. As expected, participants who directly paid for their coverage spent less, but the lower use had ‘minimal to no effects on health status’ when patients had financial incentives to ration their own health care, according to Joseph Newhouse, the health economist who ran the experiment. If we want to lower health care costs so more can afford treatment and all can avoid wasteful spending, we can attempt reform in one of two ways. From the bottom up, we encourage entrepreneurs to find solutions to fix the health insurance crisis by eliminating mandates on what insurance must cover, allowing health insurance companies to compete across state lines and eliminating tax incentives that encourage employees to purchase insurance collectively through their employer. Or, from the top down, we can set up system of ‘death panels’ that determine which treatments are worth pursuing. My soul chafes at the thought of a government body determining my level of care, but if the government is going to distort health decisions, it might as well force us to only use productive procedures. We live in a universe of scarcity so medical rationing is necessary. The current system doesn’t allow people to process trade-offs, and it has resulted in disaster. It is irresponsible to support a health care policy that doesn’t feature massive free market reforms or the death panels tea baggers are screaming about. Daniel Morgan is a 21-year-old economics senior from Baton Rouge. Follow him on Twitter @TDR_dmorgan. – – – – Contact Daniel Morgan at [email protected]