Hypothetically, a patient who has a slight chance of having a disease that can be detected by an expensive test will always choose the test, since most or all of the money will be paid by insurance.

As the author points out, insurance money comes from all of us, and nowhere else, because there is nowhere else.

It is a classic case of the “trajedy of the commons.” http://en.wikipedia.org/wiki/Tragedy_of_the_commons (a dilemma in which multiple individuals acting independently in their own self-interest can ultimately destroy a shared limited resource even when it is clear that it is not in anyone’s long term interest for this to happen).

As the author points out, the current drive for reform does not address this. I still support the reforms because of the easy ride from employed and insured to unemployed and bankrupt.

However, as the author points out, eventually we are all going to have to face the music (financial and otherwise).