My latest essay on health care policy:

I think it is useful to divide the health care issue into three areas: general wellness; acute care; and discretionary procedures. The problems and solutions differ by area.

What I mean by general wellness is engaging in healthy lifestyles and reducing risky behavior. Sometimes the term “public health” is used to cover this, but to me that suggests that government bears the ultimate responsibility. In fact, we should recognize the importance of individual behavior…

in economic terms, it is not clear that the people who pay for cosmetic surgery are doing anything worse than people who pay to build ski chalets in Aspen. Either way, you are using up resources for a luxury good. If you build a chalet, that is your business, and if you choose cosmetic surgery, that is also your business.

There is a sense, however, in which the concern about discretionary medical spending is quite valid. Your medical decisions become my business when I pay for them through Medicare or other government programs.

Meanwhile, Nick Schultz points me to a New York Times article on Canada’s healthcare system.

medical professionals and local officials say a major reason it may not be easy to address the problem of slow access to treatment is because doctors who do preliminary diagnostic work, refer patients to specialists and monitor the care of chronically ill people are less and less available – especially in small towns and rural areas…

Young doctors are more likely to seek the most lucrative work in cities or go to the United States rather than start more modest practices in small towns because of growing debts when they leave medical school.

For Discussion. Is there a reasonable way to distinguish discretionary care from acute care?