One of the critical long-term problems with U.S. health care is that short-sighted political fixes such as the woefully misnamed Affordable Care Act are oriented toward subsidizing the consumption of medical goods and services while doing nothing to encourage their production, indeed discouraging their production through things like price controls and punitive taxes on medical devices. When a growing number of dollars are chasing a supply of goods that is if not fixed then not growing nearly as quickly, the likely result is higher prices rather than wider consumption. Which is to say, it will encourage a move away from the sort of prosperity contemplated above — and that, not the operation of markets, is what is actually monstrous, because it makes people’s lives unnecessarily worse in order to satisfy various kinds of political ambition. Example: The ACA will increase demand for primary-care physicians, but by 2020, the United States will be 45,000 general practitioners short of its medical needs, and 65,000 just five years after that. The political response to that economic reality, in the ACA and elsewhere, is to attempt a restitution through fixing prices, organizing producers into cartels under political discipline, and further inhibiting the operation of the market. We have been doing that to U.S. health care for more than a half-century now, and the cost of those decades of stupidity is manifest in the current dysfunction of our medical markets, in which there is no strong relationship between the price of goods and the ability of consumers to pay for them.

To revisit the automotive analogy, if we subsidized and mandated Rolls-Royce levels of consumption without accounting for the fact that the gentlemen in Goodwood produce only so many cars each year, the result will not be more Rolls-Royces; it will be Honda Civics that cost $100,000. And that is approximately where we are with health care.