RES PUBLICA

Politics, Politicians, and Current Events Examined

Somebody Get Me A Doctor

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COMMENTARY

By Korso

Picked up an interesting story from, of all places, MSNBC.  It details how some dental and medical practices are getting rather aggressive with pushing elective procedures that aren’t covered by patients’ insurance plans.  This struck a chord with us personally, as our general practitioner likes to order up expensive (and unnecessary) vitamin tests during routine blood panels–stuff that adds over $100 to the bill, which we have to pay out of our FSA.  And that ain’t all.  The last time Korso’s wife went in for a visit, she asked about a raised area on her skin and got offered an expensive lightening cream.  As she put it, “I asked if it was worth seeing a dermatologist over and they said no.  So I told them no thanks to the cream.”

Now far be it from us to decry our GP for trying to make a few extra bucks.  We firmly believe that he, along with the vast majority of doctors, are providing a good, honest service to the best of their abilities.  That said, there are some ethical issues raised by this practice of selling these optional extras while you’re in the office for a physical or a consult.  After all, we look upon doctors as authority figures–and people tend to heed authority figures, often without asking questions (if you don’t believe us, check out Stanley Milgram).  Consequently, patients may feel pressured to buy whatever the doctor is trying to sell them, regardless of whether or not they need it.

The reason we bring this up is that under Obamacare, you’re probably going to see a lot more of this.  Medicare reimbursement rates are already squeezing doctors pretty hard, making it nearly impossible for them to recoup the cost of treating Medicare patients;  and with a half-trillion more in cuts headed our way under the new law, things will only get worse.  Couple that with the long, drawn out process of getting insurance companies to pay out claims, and what you have is a real incentive for doctors to make up the difference by selling these boutique services on a private-pay basis.  So you better get used to it.

We know it’s hard to believe, but there was a time when people paid for most of their health care this way.  Medicine was a service, much like any other:  you saw the doctor, you wrote him a check, you went on your merry way.  Costs were reasonable, because doctors had to compete for your business–and insurance was just something you used to cover serious expenses that you couldn’t afford to pay by yourself.  When Congress tied health care benefits to employers back in the 1970s, though, they started a scheme that has metastasized into what we have today:  insurance pays for everything, putting a huge bureaucracy between you and your doctor.  Patients no longer care how much anything costs, because they don’t really know how much anything costs.  And like clockwork, both premiums and costs have skyrocketed as a result.

Think of things this way:  How much more would you be paying for car insurance if, in addition to accidents and liability, your policy also covered routine maintenance–brakes, tires, transmission, what have you.  Sounds crazy, right?  Now let’s look at costs another way:   Say you had an insurance plan that covered your groceries, and you only had to cough up $20 each time you went to the store.  Would buy canned spaghetti, peanut butter and Kool Aid–or would you splurge on steak, lobster and Dom Perignon?  Makes no difference to you, because it’s all the same co-pay.

Neither of these would work, would they?  The car premium would be too expensive, and the grocery shopper would have no incentive to shop for bargains.  Substitute “health” for “car” and “care” for “groceries” and you have a pretty good picture of our modern-day health insurance system.

So what’s the answer?  Our president seems to think it’s more insurance–which is what dug us into this hole in the first place.  In fact, he’s so enamored of health insurance that he’s made it illegal not to have it.  What’s missing is an explanation of how this is supposed to keep costs down.  Perhaps that’s because it can’t–at least not on this planet, where the laws of economics remain firm.

It’s high time we tried something different.

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Written by Korso

May 19, 2010 at 5:27 pm

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