Washington’s var­i­ous schemes for “health care reform” have dom­i­nated the news for months now. Every­one seems to think that health care could be done bet­ter, but the indus­try is so com­plex and so full of out­spo­ken stake­hold­ers that the signal-to-noise ratio of pub­lic dis­course has become unbear­ably low. Rather than seek out the facts, I tune out. Just fig­ure some­thing out, okay?

David Goldhill’s Sep­tem­ber cover story in The Atlantic pro­vided an invig­o­rat­ingly fresh per­spec­tive on the prob­lem. He pro­poses some really great ideas, but most impor­tantly, he rede­fines the prob­lem. Here I sum­ma­rize (some­times with direct quotes) some of the most salient points from the first half of the article:

Health care does not equal health. With the best of inten­tions, we acci­den­tally cre­ated a “heav­ily reg­u­lated, mas­sively sub­si­dized” health-care sys­tem lined with all the wrong eco­nomic incen­tives. “Incen­tives that empha­size health care over any other aspect of health or well-being. That empha­size treat­ment over pre­ven­tion. That dis­guise true costs. That favor com­plex­ity…” Fed­eral spend­ing on health care out­strips edu­ca­tion by a fac­tor of 8. How, he asks, does a soci­ety deter­mine that $100 bil­lion for health care will make us health­ier than, say, $25 bil­lion for bet­ter nutrition?

Health insur­ance is not health care. “How often have you heard a politi­cian say that mil­lions of Amer­i­cans ‘have no health care,’ when he or she meant they have no health insur­ance? How has a method of financ­ing health care become syn­ony­mous with care itself?” Most forms of insur­ance are designed to pro­tect the cus­tomer from the costs of rare, unan­tic­i­pated events—like a car crash. But we have become strangely com­fort­able with the bizarre idea of using health insur­ance to pay for every­day med­ical expenses, even when expected long in advance.

Gov­ern­ment is not good at man­ag­ing cost reduc­tion and fos­ter­ing com­pe­ti­tion. Exist­ing gov­ern­ment plans, such as Medicare, have failed to con­trol costs because they equate costs with prices. “Cost con­trol is a fea­ture of decen­tral­ized, com­pet­i­tive mar­kets, not of cen­tral­ized bureaucracy—a mat­ter of incen­tives, not man­dates.” Ad-hoc price con­trol cre­ates unforseen incen­tives on the types of ser­vices hos­pi­tals and clin­ics want to offer and the fields of prac­tice cho­sen by young doc­tors. Fur­ther­more, the strange rela­tion­ship between insur­ers and health-care providers cre­ates a mud­dled sys­tem of pric­ing and dis­counts which does not work in favor of reduc­ing costs for the patient—because the patient, in our sys­tem, is not the consumer.

Amer­i­cans my age have never known a dif­fer­ent sys­tem. It’s good to ques­tion your assumptions.