Living in medical fantasyland

The Providence Journal: U.S. House Budget Committee Chairman Paul Ryan, R.-Wis., is willing to take the heat for his plan to essentially privatize Medicare. But, except for the last item here, Mr. Ryan, a self-proclaimed Ayn Rand disciple, doesn’t really address the biggest causes of U.S. medical-cost inflation. (The crank Ms. Rand, by the way, went on Medicare.)

A fee-for-service-based system that encourages extreme waste and duplication and drives up costs.

A private insurance sector whose shareholder mandate is to charge the maximum it can. Mr. Ryan wants to give the sector, which has a worse record than Medicare in controlling costs, even more power.

Insured patients and doctors ordering up any and all tests and other procedures covered by insurance because “someone else will pay for it.”

A focus on hyped and very expensive technology often grossly incommensurate with outcomes.

Wasteful “defensive medicine” stemming from the litigiousness of our society.

Except for the last item, Mr. Ryan’s avoids medical-economic reality. But then, so do most Americans, even as they complain about soaring costs and shrinking access.