MONDAY: We're so old that we can remember...

MONDAY, DECEMBER 22, 2025

...when Paul Krugman wrote about this: On December 13, the New York Times ran a guest essay concerning the cost of health insurance. Headline included, the essay started like this:

$27,000 a Year for Health Insurance. How Can We Afford That?

The debate over whether to extend the expanded Affordable Care Act subsidies has consumed lawmakers over the past two months, precipitated a government shutdown and sparked Republican infighting. Unfortunately, it’s the wrong debate.

While I believe we should extend the subsidies, which expire at the end of the month, to help families pay their insurance premiums, doing so wouldn’t fix the underlying problem: surging health care spending. That’s the reason we need the subsidies in the first place, and it’s bankrupting families and shredding jobs for low- and middle-income workers across the economy.

And so on from there. The essay was written by Zack Cooper, an associate professor of public health and economics at Yale.

Topics like that have largely slid beneath the waves in this modern era, in large part due to the flooding of the zone. Distractions come thick and fast these days. Who has time for a discussion of a topic like that?

It occurred to us that it's been a while since we reviewed a basic type of health care spending data. Why does our nation's "surging health care spending" seem to exceed that of other comparable nations? 

Nostalgically, we started to click. Soon, we came upon these data, courtesy of Peterson KFF:

Health expenditures per capita, U.S. dollars, 2023 (current prices and PPP adjusted)
United States: $13,432
Germany: $8,441
France: $7,136
Canada: $7,013
Australia: $6,931
United Kingdom: $6,023
Japan: $5,640

Peterson KFF includes a "Comparable Country Average." It includes the spending figures from some smaller Euro nations. That average is said to be this:

Comparable Country Average: $7,393

People, we're just saying!

We've been puzzling over numbers like that ever since Paul Krugman did a series of columns on this topic back in 2005 or 2006, also for the New York Times. From that day to this, we don't think we've ever seen a major news org tackle the challenge of attempting to tackle this question:

Why do we Americans spend so much more, on a per capita basis, than other nations do? 

Why do we Americans spend so much more? The daily flooding of the zone makes it even less likely that you'll ever see a serious effort to tackle a question like that.

Meanwhile, if someone did develop such information, the findings would be sifted in different ways within Silo Red and Silo Blue. We've become a spectacularly unintelligent nation, which, just to be perfectly honest, doesn't differ all that much from The Way It Always Was.

We've shown you the start of Professor Cooper's essay. Before long, he's also saying this:

...Rising health care spending is killing the American dream.

Despite devastating out-of-pocket costs, Americans are generally insulated from the true cost of health care premiums. However, the expiring subsidies on the Affordable Care Act marketplaces, where more than 20 million Americans get their insurance, show just how exorbitant premiums have become. Consider a 60-year-old couple earning $85,000 a year. Without subsidies, their health insurance premiums next year will approach $32,000 (akin to buying a new Toyota Camry).

Those of us who get health care insurance from our employers—some 160 million Americans—may be breathing a sigh of relief. But our health care premiums are also staggering (an average of $27,000 a year for a family of four), and the fact that our employers pay part of the tab isn’t much of a reprieve.

That’s because decades’ worth of research shows that, even though employers pay most of workers’ premiums, those costs are passed on to workers in the form of lower wages and fewer jobs.

There's a lot more to Cooper's essay than that. But such essays lead nowhere within our flailing American discourse. Thanks to the incessant flooding of the zone, that discourse is almost surely dumber now than it's ever been before.

At one point, we Americans occasionally pretended to discuss such topics. Those discussions rarely went anywhere, but today we pretty much don't even bother.

The zone gets flooded all day long. Inevitably, our attention is drawn to the endless string of inanities which rush through as part of the flood.

Way back when, Paul Krugman tried to make this a topic. Through zero fault of his own, Paul Krugman tried and he failed.