The WSJ editorial board, shooting at sick people
Tuesday, June 9 2009
The members of the Wall Street Journal editorial board either have perfect health, or a virulent strain of contagious rectocephaly:
A far better alternative is to increase individual responsibility for medical decisions. In 1965, the average American paid more than half of his health care out of pocket. Spending has since increased sevenfold, but the amount that consumers pay directly hasn’t even doubled. When people aren’t exposed to the true cost of their care — though it is paid in foregone wages and higher taxes for public programs — they consume more care.
The WSJ fix for health care is that patients pay for more of their care. Great, sign me up: I already can’t afford my COBRA payments, can’t pay the bills for the doctors I have seen, and can’t afford to see a dermatologist about this gigantic mole on my butt. I’ll be spending the money I get from my insurance company for my wrecked car – whenever that shows up – to cover my COBRA payments and in the meantime I’m avoiding treatment and skipping prescriptions. Oh – and let’s ignore all the time I waste waiting for insurance companies, scheduling operators, billing clerks, doctor’s appointments, medical suppliers, pharmacists’ assistants. (It’s a fact little-appreciated by the medical community that one of the symptoms of Crohn’s disease and any other illness is that your time suddenly becomes value-less.) By all means, let’s make sure I see more of the true cost of medical care.
Of course, one might argue that patients already have tremendous responsibility for their medical decisions in the form of their actual physical well-being; you’d need a tape measure and a calculator to tally up all the scars on my body that resulted directly from medical decisions. And while I’m branded forever with the responsibility for those decisions, I almost never had any authority to make them. I don’t, as it happens, get a lot of say in what treatments I refuse and what alternatives I pursue. My doctors tell me what they want to do, my insurance tells me whether they’ll pay for it, and my only real decision is, do I go along or go AMA?
Making patients pay more for their care won’t increase their authority. It won’t even increase their responsibility. It will increase their vulnerability. It will mean more sick people suffer for lack of care. President Obama’s reforms may or may not give us patients any more authority, but it should at least decrease our vulnerability.
The WSJ is at least right to note that, “Caught in the political crossfire will be patients, as they always are”. But as a patient in that crossfire, on behalf of patients everywhere, I wish the WSJ would do us the favor of not shooting at us. I have enough scars already, thanks.
(via NOW! Blog)
The point is that the moral hazard of any individual third-party payor is partly responsible for the skyrocketing of healthcare expenditures. Moral hazard is a beast, affecting both patients and physicians, insulating both from the pressures of monetary costs.
The physician says: “Let’s order this MRI to rule out a tumor.”
The patient says: “Ok, it’s a low risk, but I’m not paying for it, so go ahead.”
Look at it this way: the average American already has a heavy tax burden which goes towards subsidizing employer-provided health insurance through tax breaks and government-provided health insurance through FICA. The recipient in all this does not realize that the high taxes already paid goes towards funding healthcare.
If taxes were decreased and thus the taxpayer receives a larger take-home income, then more money at the discretion of the taxpayer is available to pay for healthcare costs. “At the discretion” is the key phrase.
They are not saying you should pay more than you already are for your healthcare. They are saying that the system should be structured in such a way that you realize that you are already paying for healthcare costs.
Reduction of moral hazard is the key.