Why are Italians so much smarter about medical costs?

John Kitzhaber, the former governor of Oregon, is seriously considering another run for the office. The foundation of his campaign, we are told, would be an effort to resolve Oregon's health care crisis, which is just a microcosm of the one national problem.

One of the points he is making is that we could probably cobble together about $2000 per person in Oregon through existing government expenditures, between actual expenses and tax breaks for medical insurance. That's about the amount Italy spends per capita to provide health care for all its citizens, with better health outcomes than we have in America.

I just saw a doctor about a problem and was given a prescription. I think it's a fairly new drug and it seems to be helping. A few years ago, it would not have been available. If I knew what it was costing and was paying out of pocket, I would consider whether the new drug was enough better than the old ones, or none at all, to be worth the price.

But since I have health insurance that includes prescriptions, I don't face that choice. If I decide to be frugal, the beneficiary will be my insurance company. Next year, my decision will be averaged statistically over everyone, both frugal and indulgent, to calculate the undoubtedly higher premiums that companies will pay.

The American system combines the bad aspects of private enterprise and socialism. The health care industry has little incentive to control costs, since they will be recouped from almost everyone, and in fact a doctor who prescribes less than the best may get sued, even if the increment is not worth the cost. Congress recently exacerbated the situation by denying states the right to insist on cheaper and nearly equivalent mental health drugs.

A single payer system would control some of the waste, but when it went on the ballot in Oregon, it was crushed. We need single payer and also a change in attitude. Everyone deserves a basic level of health care. For things that are optional, consumers should understand the costs and bear them personally. I'm not optimistic that we can achieve that in Oregon or anywhere else.