The health industry is driven by expectations. Patients with some exceptions expect everything to be done no matter the cost or limited benefit. They also largely expect that no matter the severity of the illness and difficulty of treatment that they will be the ones cured–that’s what it said on TV or the Internet. Doctors expect a handsome income to pay off their overhead, loans and standard of living. The medical technology industry and their sharholders expect double digit yearly returns on investment and aggressively marketed questionable advances. Hardly anyone in the non system bothers with lack of value, comparative efficiency, or the cost of all this.
The medical industrial complex discovered some time ago (in oncology the turning point was the mid 80’s) that medical consumers and doctors are price insensitive–Doctors and other suppliers of goods and services because they are doing well the more “good” they do; hospitals because they can pass through the cost of their inefficiency; insurers ditto; pharmaceutical manufacturers and other suppliers because patients and the non-system pay whatever is demanded.
Our non system works (if 17% of GDP can be called working) because the patient is shielded by insurance and/or has the expectation that one way or another someone else will pay. The R word (rationing) has been raised in the health care discussion. What’s obfuscated, however, is a fact that we’ve always rationed care by access and cost. And no matter the congressional/political verbiage we’ll continue to ration in the future, perhaps even more.
As health care changes, increased financial participation by patients is inevitable. The question is how to implement. I have reservations about health savings accounts and cut rate insurance because only a small portion of the population will actually be able to “save” in these accounts (check out the retirement savings at various ages in the U.S., the money isn’t there). And because what’s cut in cut-rate coverage is access and coverage.
Simply providing insurance with a floating rate deductible, applicable to all, based on income has more appeal but in our bizarre political world anything that seems to offer the possibility of service to all draws the ire of a obnoxious vocal minority (my opinion).
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