Governmental regulators, politicians, public health officials, political liberals, and policy mavens (wonks, in other words) espouse the Wonkonian school of thought.

Wonkonians believe that the root cause of the problems in our healthcare system lies in human weakness (specifically in too many greedy doctors using too much expensive technology). The fix for these problems therefore rests in setting policy and promulgating regulations to hold that greed in check. Philosophically, Wonkonians believe in original sin, in the essential evil of man - if you give a fellow too much freedom, he’ll probably do something bad.

That the traditional (Tooth Fairy) Quadrant IV healthcare system institutionalized the natural human greed of physicians supports the Wonkonians’ argument. Under that Quadrant IV system, the more technology doctors use, and the more procedures they perform, the more money they make. This system fosters profligacy, waste, and the overuse of expensive resources.

According to the Wonkonian school, the greed inherent in our healthcare system is confirmed by the fact that millions of Americans are shut out of the system (or at least shut out of health insurance). Where is the cry of outrage from our “compassionate” physicians over the high number of uninsured? The greed is further reflected by a lack of quality in our present healthcare system - consider the high infant mortality rate and lagging life-expectancy in the U.S. as compared with rates in other developed countries. Again, where is the professional outrage? Clearly there is a fundamental problem with our healthcare system, a problem that stems from the misguided incentives and maladjusted motivations of healthcare practitioners and other profiteers.

Politicians and policymakers gravitate toward this school of thought because its basic premise is that the problem with healthcare results from misguided incentives coupled with human greed. This premise places the solution in the hands of policymakers, who can do the job with stricter regulations and more enforcement muscle.

On the other hand, many of my physician colleagues in those days, as not-quite-disinterested observers whose incomes depended on society’s willingness to spend lots of money on healthcare, were saying: Who says thirteen percent is too high? If not healthcare, what should we spend the money on? Caribbean cruises? Sports cars? Why not spend twenty or twenty-five percent or even more of the GDP on healthcare?
I cannot blame my doctor friends for asking a question as reasonable-sounding as this one. The correct answer, however, is not the one they expected. For there is indeed a fundamental limit on how much society should spend on healthcare. We were exceeding that limit in 1994, and we’re certainly exceeding it now.

That limit is defined by a straightforward economic principle: When we are buying consumable products that we are consuming ourselves - products like Caribbean cruises, sports cars, ice cream, and healthcare - we should spend no more than we are able to pay ourselves.
We are spending more on our healthcare than individuals are able to pay, and we have been for quite some time. In 2002, for instance, we spent an average of $5,440 per year on healthcare for every person in the United States. This is far more than most Americans could comfortably pay by themselves, without the benefit of employer-supplied, taxpayer-subsidized health insurance.

More importantly, this amount is greater than we are able (or at least willing) to pay on a collective basis. Instead of paying for our healthcare as we go, we’re adding much of the cost to the national debt. The expense accrues to the debt two ways. A big chunk of American healthcare is provided directly through government programs like Medicare and Medicaid. But even private healthcare is supported by the government through tax deductions for insurance premiums; so even for those of us with private health insurance, much of the cost of our healthcare gets added to the national debt. Thus have we arranged to pass on a huge and growing financial burden to our children, grandchildren, and generations yet unborn, in violation of the principle that those who consume products or services ought to pay for them.