At President Obamas Feb. 25 Health Care Summit, Dr. John Barrasso (R-Wyo.), suggested that health care insurance be limited to catastrophic coverage. He expressed concern about those people who walk into a physicians office with a complaint and a recommendation: My knee hurts, should I get an MRI? Presumably these people would be less inclined to suggest a costly procedure if they knew they would have to pay for it themselves. The trouble is, its impossible for the average patient to be an efficient consumer of medical services; that has always been a flaw in the system, and its getting progressively worse.
For decades now, weve been stuck with the false theory of the efficiency of markets. This was a notion, developed at the Chicago School of Business, that markets represented a collective wisdom, and would always adjust prices to account for information, so that the price of a commodity, whether its an apple or a share of stock, always represents the proper price. This is nonsense, and the fallacy has been recognized for decades, but unfortunately it hasnt always been recognized by the people responsible for managing our economy. At any level, economic decisions are based on complex emotions as much, if not more, than they are of knowledge. Even when the decisions are presumably knowledge based, the knowledge required may not be generally available, or the people with the information may not have the skills to interpret the facts. This is a common problem in any field that works with modern technology the knowledge becomes so specialized that hardly anybody can be considered an informed consumer. Medical care is a prime example. Dr. Barrasso is given some credibility because he is a physician, but according to the American Board of Medical Specialties, there are currently 37 general specialties and 94 subspecialties, and you cant expect a physician who practices interventional radiology to be up to date on the latest work in pediatric sleep disorders. Areas of knowledge become narrower and narrower, but they also become deeper and deeper. Meanwhile, Dr. Barrasso expects the average patient, whose medical knowledge is limited to having caught two episodes of Greys Anatomy in reruns, to know how to spend health-care dollars efficiently.
In our current system, the patient is the consumer but she has little or no say in whether to make a purchase. The actual decision is made by a personal shopper the physician who has no responsibility for payment. Payment is made, in part, by the insurer, whether its private insurance or a government plan and the insurer has the luxury of deciding what it will pay for. So, while Dr. Barrasso and his associates are concerned with the patient asking for luxury care, the patient is the one at the bottom, with no control over the situation. When the patient asks should I get an MRI? Dr. Barrasso is free to say no, you dont need one, and if the Doctor does order the test, and Blue Cross or Medicare decides that it really wasnt necessary and refuses to pay, its the patient who has signed a statement of financial responsibility at the radiology office, who gets stuck with the bill. Market economics works when everybody knows whats being bought and sold. It doesnt apply to health care.
If we were serious about bringing the costs of health care into line, we would have two things: a research center performing well-designed studies to evaluate the cost effectiveness of various treatments, and a government based universal care system, with everybody enrolled. Both of these ideas have turned up in the course of the debate over healthcare reform, and both have been knocked off the table.
Meanwhile, John Boehner (R-Ohio), spent his time at the summit, assuring everybody that we have the best health system in the world. According to the United Nations, were actually 37th, with France, Italy and San Marino tied for first place. The only thing we can rightfully claim to have is the most expensive system but thats what happens when the decisions are made by personal shoppers in this case Congress who have no responsibility for payment. Somebody should tell Dr. Barrasso that we already have catastrophic coverage that the system we have is, and even if a bill gets through Congress will still be, a catastrophe.
Sam Uretsky is a writer and pharmacist living on Long Island, N.Y.
From The Progressive Populist, April 1, 2010
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