I talk a lot about marginal costs, because it's an unappreciated factor in space access costs, but it's also one in health care, given the lunatic way the current health insurance (including government health insurance) system is set up.

Certainly people appreciate lower marginal costs in medicine. That's why they carp about the "obscene" profits of Big Pharma when it charges $5.00 for a pill that costs $0.015 to manufacture. It's the concept of amortizing your development costs that they don't quite grasp.

In any event, aside from drugs, there aren't that many places in medicine where there possible major benefits from volume. The big cost in medicine is the price of those highly trained people. Your ICU team costs the hospital something like $400,000 a year in salaries and benefits. That's just two RNs, an RT, and a med tech gopher or two. Your doctor and the surgeon, not to mention hospital administration and janitorial staff, come on top of that $1000/day.

So how are you going to get more efficient in your use of labor? No matter how many years experience she has, a critical care nurse can't look after more than two patients at a time. Similarly, a heart surgeon is going to do a bypass in just about the same time when he's fresh out of his residency and 20 years later. He's not going to be able to drop his surgery time from 3 hours to 10 minutes, the way Dell can drop its PC assembly time by automation and improved technology.

I'd be the first to agree the health care system is a bit fscked up, and costs more than it needs to. But it has zip to do with hospitals and doctors having low motivation to reduce their costs. That's just the same old crack we smoked in the 80s when we thought HMOs were the magic bullet that would make medicine cheaper, the same old fantasy that by eliminating "waste" in government we can have our cake (lots o' services) and eat it too (lower taxes).

It'd take it as a sign of maturity if we ever stopped indulging in these sweet fantasies and started to think seriously about how we can more rationally each pay what our own health care costs, based on the ugly but inescapable fact o' life that if you want A+ superduper care that keeps you alive as long as technologically possible, from very expensive people who go to school for 20-25 years to qualify, it's going to cost you a huge chunk of your earnings. Possibly even as large a chunk as you pay the Federal government for...uh...for...um, whatever it is they do for us.