Moral hazard revisited (my blogonym explained)
Tuesday, June 30 2009
Kevin, MD has a reader take from an anonymous medical student:
One of the ideas that comes up in the search for explanations of high healthcare costs is the so-called “Moral Hazard”—the idea that insured patients are more likely to agree to unnecessary procedures because they don’t pay for them directly. Not everyone thinks it is real [...] Recently, I’ve become convinced that the Moral Hazard does exist. I’ve seen it with my own eyes.
You should know that moral hazard only comes up in ideologically-driven explanations of high healthcare costs; the phrase serves mostly as an appeal to economics to justify forcing sick people to pay more for their care. In a post titled, The Myth of Moral Hazard, I argued against such explanations.
AMS provides as an example of moral hazard an anecdote from a geneticist’s practice, where a patient gets a test that does nothing but confirm a diagnosis. AMS argues that because certainty isn’t medically necessary, this test was ultimately a waste of money – an example of moral hazard. The problem is that AMS doesn’t offer any evidence that the patient wouldn’t otherwise pay for the test herself. And I would bet dollars to doughnuts he would.
Here’s why: Crohn’s disease has a strong genetic component, but nobody else in my family has it. I am the ‘lucky’ one. And the fact that I was switched at birth may have something to do with that.
As the story goes, I was only switched briefly. While still in the hospital, my mother was handed the wrong baby. She soon realized the mistake, and shouted “Wrong-g-g-g-g Bay-y-y-y-be-e-e-e-e” at the top of her lungs. The nurses moved like the place was on fire, and brought her the right baby. I don’t know how they knew which baby was which, apart from the name bracelets, but it has occured to me that the bracelets might have been on the wrong babies.
My mom says she knows I was the right baby, too, and I accept that. But still: there is a chance that I am the wrong baby. It’s a very, very slim chance – one in a thousand, maybe – but enough to make me uncertain about my family medical history. Maybe Crohn’s is more rampant in my family than I think. And that uncertainty bothers me – not a lot, but enough that I would pay to resolve it. If I could get my mother’s consent without upsetting her, I would easily pay $300 just to find out for sure, and maybe as much as $500. I would pay a lot more if I were planning on having kids of my own – even though it has no bearing on whether they will get the disease. I would pay, just to be certain. And I would bet the same was true of AMS’s patient.
Even if I am wrong – if the patient would not have paid for the test – AMS presents a very weak argument for moral hazard being a problem in the system. By the same logic, I could argue that not putting lead aprons on x-ray subjects is a serious problem in health care, simply because it happened to me one time. I’ve seen it with my own eyes. The myth of moral hazard isn’t that it never happens; AMS will likely run into many more equally trivial examples in his career. Rather, the myth is that ‘fixing’ moral hazard – i.e. making sick people pay more for their care – will fix the health care system.
And for those wondering: the wrong baby’s last name was Cross. If your last name really is Cross, and you were born in Sarasota, and you’re the only one in your family without Crohn’s disease: please email me right now.
I am intrigued with the switched at birth story, and need more information. That story should be an entire post. Do you look like your mom, or anyone else in your family?
Weirdly enough, my second daughter did not have any ID bracelets on the day we were taking her home from the hospital. She looks nothing like her sister. I delivered in an inner city hospital with a very varied ethnic mix, rarely do we see a Caucasian patient. I worriedly asked if this baby was really mine, which the nurse replied “RR, you are the only white patient and this is the only white baby on the unit.” But sometimes I wonder………..
RR – that’s really all I know of the story myself. I don’t look totally different from my family, but I don’t look particularly like anyone. If I can find a non-creepy way to bring it up, I will ask my mom to tell me more (she doesn’t read my blog).