03/31/2010 05:12 am ET | Updated May 25, 2011

Health Care and Automotive Repair

A couple of weeks ago, an article appeared in the New York Times on the subject of health care reform--with a Colorado-centric focus. The article was written by Robert Pear, who's as good as they come in the world of health care journalism. As he usually does, Pear nails the policy details, but his opening made me chuckle. He cites Donny Sefer, the manager of an auto repair shop in Denver as being disillusioned with health care reform. Apparently, Sefer wanted Congress to figure out the underlying problem of rising health care costs and do something to fix it. That's sensible. But Sefer's also quoted saying "I am an automotive diagnostician. We look for the root cause of problems. If we treat the symptoms, the problem always comes back. With health care, we are not treating the root cause: Why does it cost so much?"

It was the question he posed at the end that I wanted to turn back on him. "Mr. Sefer, why does automotive care cost so much?" It's a rhetorical question. The answer is that, with the possible exception of urban areas with efficient public transportation systems, we are dependent on our automobiles. Consequently, it's a problem when they cease to work as they should. Mechanics possess the skills to get them working again in short order. We don't know if what they did was actually anywhere near as complicated as the price we are willing to pay might suggest. Many of us would happily pay a couple of hundred bucks to our local mechanic if they told us "Well, the problem was your flim-flam valve was glopped up, so we had to adjust the tension on the thingamabob belt and replace your do-hickey regulator." As long as she's running again, we're happy. Now for those of you who know what an idle air control motor is, maybe you drive a harder bargain, but that's not typical.

Our lack of information as consumers puts us at a pretty big disadvantage when we need something important to us to be restored to working order. And that's cars, folks. The principles at work in the mechanic-car owner relationship are only exacerbated in the context of health care. The reason why is obvious: Worst-case scenario, you can't go down to the dealership and pick up another you. If things are serious enough--say it feels like there's an elephant sitting on your chest--you'll be pretty quick to agree to just about anything without even taken cost into consideration. It's the "shopping" equivalent of going "all in." There's no other purchasing decision I can think of that works like that.

So, I was surprised that Mr. Seyfer, a mechanic, would wonder why health care costs are so high. He's in as good a position as anyone to understand the precise forces at work. We need more information as consumers, for a start. Of course, that's just for a start. There's much else that has to happen to get prices, and thus, costs, brought under control, but I just wanted to knock down the analogy that Robert Pear set up so nicely for me.

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