but if a person is high risk because of choices they make in life then shouldn't they face the costs of those choices?

How far are you willing to carry that?
If someone smokes and is dropped by their insurance carrier or is charged such an exorbitant rate that they cannot afford insurance should they be forced to do without insurance? The attendant consequences are not being able to have medical care outside of ER visits which they will most likely not be able to pay for?
What if they eat poorly should they face the same consequences?
What if they fail to exercise adequately?
What if they just live too long?

And you know how things go, subsidize something you tend to get more of that something.

So if you subsidize medical care you will get more medical care? or does this only work with subsidizing bad things?

The trick is in constructing the incentives correctly to do so.

OK. How would you go about structuring those incentives? Should people be forced to change unhealthy behaviors to get insurance or care?

I realize you may not be big on things like personal responsibility, but if a person is high risk because of choices they make in life then shouldn't they face the costs of those choices?

How do you propose we treat poor people with adult onset diabetes who don't take care of themselves and got the disease from eating like crap and never exercising?

Should we say, "Too bad, sucka" and not let them have any medical care because they can't get insurance and can't pay for the treatment? Do we just treat the acute emergency symptoms like heart attacks or strokes?

What about cancer victims? Certainly people with many forms of cancer brought it on themselves. Just let them die?

If your answer is, "yes, let them die," then I respect that. Otherwise, it's a cost/benefit issue that requires some sort of mandatory coverage and preventative care to hold down long term costs.

Going to Med school is hardly a financial deal. Doctor who "go in it for the money" learn very quickly to start liking their careers for other reasons besides financial gain. Only a few make it rich, and only by devoting themselves more to bussiness than medicine.

As Dave Schuler pointed out part of the problem is perverse incentives. Ignoring why people are high risk and covering them anyways is one of those perverse incentives. On the other hand if the person has done nothing to be high risk or ends up facing high medical costs, then we as a society might very well decide to provide that care anyways. The trick is in constructing the incentives correctly to do so. Maybe it can't be done then we really are left with an unpleasant choice.

But realize that one downside to your most likely solution, cover everyone irrespective of who they are and what kind of lifestyle choices they make, could very well end up leaving you so you can't cover anyone, or only with crappy half-way measures. Decisions in life are about trade-offs; something I'm not sure Kevin Drum has learned.

Further, Medicare doesn’t worry about things like risk.

How do you propose high risk people be covered? or should they not be covered?

Physician salaries are a pimple on the "Great Medical Beast" A cardiologist averages $270K. After Med School, Internship, Residency and another 3 years for Board Certification, that's hardly a deal. All things equal, Plumbers do better on average.

Jesus, did somebody flunk NPV calculations. Consider how much money this cardiologist will have if he works for 25 years making exactly $270 each and every year. Assuming a 3% annual increase in salary, the amount is even larger. We are talking millions of dollars. Multiply that by 100,000 doctors and you have hundreds of billions of dollars.

Add on the costs of nurses, nurse practitioners, and other health care professionals and I'm sure we can get easily into the trillions of dollars. Suddenly that is looking like one big pimple.

Physician salaries are a pimple on the "Great Medical Beast"

Nonsense, John425. In Britain, France, and Germany physician salaries are 1/3 what they are here.

Professional salaries constitute a significant portion of health care expenses and they're growing fast. While insurance costs are a significant part of the total (roughly 30%), there may not be as much to optimize. But it's part of the pie, too.

Health care costs are high in this country largely because of perverse incentives and a cartel in charge of the supply of health care. We've got to address all of the major cost components if we're going to treat the problem seriously.

On the subject of the high costs of medical school, take the question one step further: why is medical school expensive? My answer: because the demand for billets continues to be high and the number of billets is fixed.

How on earth would one measure the benefits of healthcare regulations in dollars?

The ever increasing high-tech machines are a greater issue IMHO. Byzantine billing practices often hide the fact that the MRI machine, for example, costs $2 million to buy and install and another $800K per year to run. Hospital "A" has one so Hospital "B" has to have one- regardless of utilization.

Professor Bainbridge notes: "The Economist recently reported that “by one estimate, American health-care regulations cost $169 billion a year more than they yield in benefits, and lead to 7m Americans not being able to afford health insurance.” Yet, curiously, many people want to expand the role of government in regulating health care. How very odd.

James is right, something needs to be done to reduce or at least stabilize the cost side of the equation. If nothing is done about costs no one will be able to afford insurance.

Like many of the challenges facing us the answer is a thousand different things not one silver bullet that will cure all. We are all frozen, looking for that silver bullet, instead of starting to work on the thousand small solutions.

First, it's not an "entitlement" if everyone's paying for it in taxes, unless private insurance for which you pay premiums is an entitlement.

Well, no. Private insurance provides coverage based on what one contributes and, unless one has insurance that covers disability, stops when one stops contributing. Medicare -- especially a variant that kicks in the second one hits 21 regardless of contribution level -- would guarantee the same benefit regardless of contribution.

Second, while it does nothing to control costs, it's arguably a necessary *step* to controlling costs. CMS would be in an ideal position to monitor healthcare costs and procedures and to make adjustments accordingly.

They're already the 800-lb. gorilla in the room -- they decided Nexium wasn't any better than Prilosec and cost more, they quit paying for Nexium, the private insurers did the same thing within weeks if not days. One small example.