US President Donald Trump speaking next to Speaker of the House Paul Ryan. Photo: Reuters/Joshua Roberts

Our sources in Washington say that the House will vote up some version of the Trump-Ryan health care bill. The bill will be terrible and make everyone unhappy, but the Republicans will support it (probably after some cosmetic changes approved by the White House) in order not to look ridiculous.

The long-term solution to the health care cost bubble is technological innovation to cheapen the cost of delivery of services, but that would require consumers to bargain in the marketplace for services they pay for out of pocket. As long as a huge constituency views health care as a free good, this never will happen. In the meantime the US has to provide more health care to an aging population with comparatively fewer healthy young people to pay into the system. That means that some combination of patients, doctors, or taxpayers must suffer.

Different countries have different solutions. Britain’s National Health Service doesn’t spend money to keep old patients alive for another year or so, one of the biggest costs to any system. Germany pays its doctors miserably. Obamacare gave America the worst of all possible worlds (less care, higher effective taxes, and less compensation to physicians). The Republicans for the meantime have no choice but to vote up a sow’s ear and call it a silk purse.