Kirsten Mortensen's blog

One of the things that bothers me about the healthcare reform debate is that we conflate the terms “costs” and “spending.”

Here’s an example that illustrates why I think we need to be careful about this.

Clinton Memorial Hospital (Ohio) purchased an x-ray machine in 1950 for $2800.

Plug that number into an inflation calculator and the same machine, today, would cost $61,043.96.

But as near as I can tell in a few minutes of Google research, standard x-ray machines today cost maybe 3x as much as they did in the 1950s.

In other words, for this piece of equipment at least, “costs” haven’t risen at all. On the contrary: in inflation-adjusted dollars, the cost of standard x-ray machines have actually gone down.

Why does this matter?

Because in a capitalist economy, where people have been relatively free to spend as they wish on healthcare, and where people place enormous values on their health and quality of life, then they will likely choose to purchase more and better services.

Examples might include CT scans instead of x-rays, or digital x-rays instead of film x-rays, or requiring certifications and trainings of the radiographers who conduct imaging exams.

But that’s spending, not costs. That’s the market evolving to offer different, higher-quality services to people who wish to purchase them.

The question is: how can you make policy when you haven’t distinguished between the two?

No, you can’t. You can’t even debate it. To hijack a John Mayer lyric, it’s like punching underwater — you never can hit who you’re trying for. Because promises that “costs” will be lowered are equated conceptually with “we need to spend less.”

And there’s no way to make people spend less except force them to accept fewer or less-high-quality services.

If you blog, you’ve probably heard about the new FTC ruling.

Slate’s got a new piece up about it now.

Allowing these guidelines to take effect would be like giving the government a no-knock warrant to investigate hundreds of thousands of blogs and hundreds of millions of Facebook, MySpace, and Twitter users for … saying nice things about goods and services. [FTC spokesman Richard] Cleland tells Ad Age that a restaurant employee who gave his eatery a good review on Yelp would have to disclose. Given the billions of opinionated postings on the Web, there would be no end to FTC’s work.

Because of a pesky thing called the First Amendment, the guidelines don’t apply to news organizations, which receive thousands of free books, CDs, and DVDs each day from media companies hoping for reviews. But if the guidelines don’t apply to established media like the New York Review of Books, which also happens to publish reviews on the Web, why should they apply to Joe Blow’s blog? Regulating bloggers via the FTC while exempting establishment reporters looks like a back-door means of licensing journalists and policing speech.

This is a federal power grab of epic proportions, folks.

One more reason we need to pass the Federalism Amendment.