After “Am I going to die?”, and sometimes even before, “Is this procedure covered?” has to be one of the most asked question of Doctors. And, frankly, I resent it. I resent the fact that Insurance companies have forced their way into my Doctor/Patient relationship. I resent that they have the ultimate veto power over my health.
But, most importantly, I resent that I even have to think about Healthcare insurance.
[Truth in advertising: the major point Pandora is making is that insurance companies deny claims to boost the bottom line. I am not challenging that. I have a different focus at the moment.]
Then, in response to my original post about health care that advocated making people responsible for their own routine care, which would allow market prices to drive those costs down, Pandora responded,
The only concern I have is the number of people who would put off seeing a doctor on a regular basis because it wasn't paid for, thus allowing small illness to turn into big ones.
Okay, okay, I know that that's irresponsible, but people are irresponsible. And if they skipped the wellness visits could that raise the 20% mark? Couldn't this possibly lead to a "sicker" population?
Okay, there are two very important points here.
1. People don't want to worry about whether a procedure is covered, but somebody has to. Even in either a single-payer or government-run universal healthcare system based on the European model, there are not infinite resources available, either in terms of capital or capacity. Somebody, somewhere has to worry about what it all costs--especially if you don't. And when people think a service is free, they inevitably use more of it. There is also the problem of capacity. Capacity--especially capacity for technology-intensive treatments--has physical limits. There are only so many kidney dialysis machines in the country, and each can only service so many patients within a certain geographic radius. At some point, somewhere, somebody has got to make decisions about who receives treatment and who doesn't.
Think these dilemmas don't occur in Europe? Then you haven't been reading carefully.
2. There is the question of whether policy decisions about health care should be based on preventing the consequences of individual irresponsible behavior. Pandora worries that, if they have to pay for routine care, some people will avoid it until the problem becomes bigger, and that this will result in a "sicker" population. I have to first admit that I do not have a lot of sympathy for the idea that government should step in when people make dumb decisions about their own care [and here I am assuming she is not talking specifically about people too poor to afford any price), so I do have a bias.
However, there is another point to be made. When that routine care is free or subsidized below a reasonable market price, physicians become inundated with people who probably should not be there in the first place. Not every case of a cold, or influenza, or sprained ankle actually needs to be seen by a doctor. But in today's society (just ask a lot of general practitioners) our family physicians spend a lot of time weeding out what we used to call "ash and trash" complaints in the military. That time is not available to spend with patients who really need the care, or whose cases would profit from the extra five minutes of diagnostic time.
In either case--Pandora's or mine--there is an associated risk factor to public policy. My approach places the people who do not act responsibly at greater individual risk; her approach transfers that risk to people who have acted responsibly.
And this is the oft-unspoken nub of the problem. The devil resides in the details of the implementing philosophy of any health care system, free-market, government-run, or mixed.
Do we allow people to suffer the consequences of their own responsible or irresponsible actions, or do we argue that the greater societal costs of not forcing/subsidizing them to do what they ought to do for themselves in the first place is a good reason to have a system that forces them to act responsibly. And, in so doing, takes more freedom and resources away from those who would have acted responsibly on their own.
A forestaller for nemski: none of this conversation is (at least not yet) aimed toward the poor or the working poor. I am primarily (and I think Pandora is, too) talking right now about the middle-class folks who already have access to some form of health insurance. We'll get to poor people in a little while.