Health care contradictions?

We've been spending a lot of time at JBU thinking through health care issues. Gladwell, apparently, has been struggling with these same issues. But I'm confused by the apparent contradictions in his two main pieces on the topic. The first, in 2004, basically says that we don't need to spend hundreds of dollars a month Celebrex when for 99.9% of people, ibuprofen will do just as good of a job. If people were spending their own money for such things, and if the entire health care industry had to think through such cost-benefit analyses, we'd be much better off - http://www.gladwell.com/2004/2004_10_25_a_drugs.html.

But then less than a year later, Gladwell denounces the philosophy underlying his previous diagnosis, namely that of "moral hazard," as being at the heart of what's wrong with the American medical system - http://www.gladwell.com/2005/2005_08_29_a_hazard.html.

I'm confused. The system's broke because it doesn't focus enough on economic efficiency and because it focuses too much on economic efficiency.

The possible way to square this circle is to say that "basic" health care, in the form of routine dentist visits and so on, should be mandatory (either provided by the state or required of everyone that they have basic health insurance that covers such things), but that additional costs should be coming out people's pockets more directly so that they have more incentive to question whether that Celebrex prescription is really necessary.

The other way to square this circle, now that I've read up on his blog a bit more, is to say that employer-funded health care is the real problem, and that the two real solutions are either government-funded universal health care (what Canada does) or government-mandated universal health care that relies instead on individuals and the marketplace (what many states currently do with auto and home insurance). Either alternative is better than the current solution that only we in the U.S. developed after WWII. On that point, I can probably agree.