By: Ryan Holland

Last week I had the chance to attend an event hosted by Health Affairs, called “The New Urgency to Lower Costs.”  The topics addressed were pretty dry by themselves, and I found myself most interested during Q&A.  Some members of the audience seemed to be more passionate about health care reform than the experts who were presenting.

One lady in particular threw out a surprisingly controversial comment.  I called her Mrs. Pickles.  “There is all this talk of supporting our aging population, and extending life” Mrs. Pickles challenged, “but the longer we keep people alive, the higher health care costs we incur.”

The panelists shrugged off her comment and moved on, but I think that the issue Mrs. Pickles raised is crucial to consider, because it provokes thought about what role we expect government to take in health care.  Costs are rising rapidly, particularly for the poor (under Medicaid) and the old (under Medicare).  It makes sense for the government to try to reduce risky behavior (smoking or eating junk food, for example), so that the costs associated with these behaviors, (lung cancer, diabetes) decreases.  A side effect to such efforts is increased life spans, however longer life spans also means to higher health care costs.

We have seen in the case of smoking that the government can be very effective in discouraging risky behavior through advertising restrictions, taxes, and public awareness campaigns.  As a consequence lung cancer has been greatly reduced, and those who would have smoked are living longer.  But those same people will most likely develop multiple ailments later in life, beyond when they would have been expected to live had they smoked.  Which scenario is less expensive as far as health care costs go would require in-depth research but could have very interesting results.  It could be the case that it is actually cheaper to not discourage risky behavior, let people smoke, and die younger.

This raises a sort of moral dilemma: big government intervening in personal choice and expression vs. a sicker population dying earlier because advertising and misinformation are unregulated.  What do we really want the role of our government to be?  To lengthen American life as long as possible, no matter the cost?  Should it employ cost-benefit analyses to determine “optimal” public health?  And is it government’s place to dictate what is “best” for our health, and incentivize us to follow their recommendations?   In the “new” urgency to reduce health care costs, we need to consider what kind of government we want in the end.