The hypothesis I'm going to offer is not definitive, and is not meant to be. But my read of the evidence is that at the root of our health care problem is an almost pathological aversion to making hard choices -- an aversion that has, in its steadiness and implications, become the most consequential choice of all.
At the risk of cannibalizing an upcoming print feature, health care costs are on autopilot. In other areas of life, decisions are made based on whether a particular use of money is a good value as opposed to other uses of that money. Given a budget of $10, a hungry journalist who wants to expense his lunch must choose between the sandwich and the soup. He cannot choose both.
The American health care system doesn’t work like that. There is no budget. We don't want one. We’re profoundly uncomfortable saying that a person’s life, or health, is not worth the price of a particular procedure. And so we don't. We are too terrified of waiting for a procedure to even think of not providing it. We ask only that the procedure be proven effective against a placebo. Beyond that, we make no decisions, and we prefer it that way. Better to let five people die passively than kill one consciously.