My worry is that many schemes that are based on offering people many various levels of care at various prices are trying to take advantage of the following:

1) A person at Time 1 not having adequate understanding of the desperation of himself at Time 2 in case he is rendered bankrupt by medical bills. (ala, say, Jon Elster’s volume on The Multiple Self).

2) People’s general lack of understanding of the cost of medical care, leading to things like the Florida Medicaid cap on payments of $25,000 per beneficiary per year.

You say “We can’t afford all of the things we want” in health care, and I agree. The key question is: how is the rationing to be done? Is it to be done solely via money, all the way down? Or are there ways of committing ourselves, societally, to some robust minimum of care, and then letting people bid for things above the minimum?

I am in favor of a healthy, robust minimum of care because I don’t want people stuck spending dozens of hours reading the fine print on insurance policies to be sure they aren’t bankrupted by some exclusion.

Of course you do. Especially when you’re not bearing the entire cost.

And since the chronically ill routinely consume the majority of health expenses, perhaps reform should focus on their perspective…

This is a recipe for medical costs to spiral out of control even faster than currently projected. And it’s either naive or disingenuous to focus on the benefits of medical reform without examining their costs. We can’t afford all of the things we want.