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medpundit |
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Wednesday, October 23, 2002Your article in Tech Central Station fails to acknowledge the negative impact of controlling health care costs by erecting financial barriers to care, a characteristic of the consumer-driven health care movement. The sole "benefit" is to reduce health care spending. But the health policy literature contains innumerable studies confirming impaired outcomes when patient cost-sharing is used to control utilization. As you are aware, the market competition model has failed to control costs, but the single payer model has been proven to be effective. The California Health Care Options Project has confirmed that it would also be effective in the United States (www.healthcareoptions.ca.gov). The reason queues would not be a significant problem is that we already spend $5757 per capita (CMS), more than enough to assure adequate capacity in our system. Now, more than ever, is the time to look at all models of reform. No model is perfect, but they vary tremendously in their impact on the health care of the nation. Well, I don’t think that having patients pay for run-of-the-mill care counts as “erecting financial barriers to care.” I’m not at all aware that the market competition model has failed to control costs or that the single payer model has proven to be effective. We haven’t had a purely market competition model in this country for over fifty years, and other countries (scroll down to "For Example") who have single payer systems don’t seem to be doing so well. England has to recruit doctors from overseas, and many patients travel outside of Britain for procedures, at great expense to themselves. Australian doctors and New Zealand doctors are unhappy, as are the patients. And Canada is having trouble recruiting and keeping doctors. I’m not so sure about those studies that show impaired outcomes when patient’s share the cost of their care, either. What studies are those? We may spend $5757 per capita now on healthcare, but you can bet that in a single-payer system that spending would go up. There's just no incentive for anyone to pay attention to the cost of their choices when a third party pays. No incentive for the doctor. No incentive for the patient. And a large part of modern medicine is about choices. Do you want to be on an $80 a month cholesterol-lowering medication to reduce your chances of a heart attack from 15% to 12%? In today's climate, your doctor will just tell you to take it, it's good for you. Any risk reduction, no matter how small, is good, especially when no one but an insurance company has to consider the cost. In a cost-sharing model the doctor, as well as the patient, would be forced to honestly examine the cost involved in taking that medicine. My correspondent would probably categorize that as a barrier to good care, but it's really just an honest acknowledgement of its marginal worth. As for the California Health Care Options Project, it deals largely with the issue of the uninsured and assumes that the greater good is to have universal insurance coverage. (warning: pdf file) Interestingly, the uninsured interviewed for the report don’t seem all that eager to have health insurance. Thirty-three percent of the uninsured interviewed said that they “can get needed care for less than the cost of insurance.” And furthermore: Over 40% of respondents agreed with a statement "Health insurance is not a very good value for the money", while almost 40% agreed with a statement "Going to public or free clinics for my medical care is just fine with me." (At most public health clinics and “free” clinics the working poor are charged a nominal fee or a sliding scale fee based on their ability to pay, something that every doctor used to do once upon a time. Now, however, most doctors, rightly or wrongly, interpret Medicare rules as saying that you can't charge one person less than another without committing fraud.) The other side of the coin came from the Cascade Policy Institute, based in Oregon, which sent along a link to a very well-written article on the economics of health care, First, Do No Harm(warning: pdf file). It’s a remarkably good read, although I don’t agree with all of his positions on the pharmaceutical industry. The author, an economist, puts to rest several myths about healthcare costs, including several of those mentioned above. The most salient: ....many health events are so common and minor that they are likely to befall most everyone in the population, with the consequence that there is little advantage of risk sharing through insurance. Specifically, the pro-rata cost of sharing the burden of common and minor events through private or public insurance will actually be greater than the cost of bearing it individually because of the administrative cost of the insurance. In such cases, there is no natural insurance market. This is why routine house painting costs are not insurable, but a house fire is. And that’s why health insurance costs are so high today, and why the ranks of the uninsured are growing. We’re paying for the medical equivalent of house painting. It's also why the uninsured have trouble paying for the healthcare that's available today: If the inflation rate in medical services exceeds the nominal rate of income growth of low-income households, the result can be an absolute reduction in the ability of poor households to afford health care services. Read it all, it’s well worth the time. posted by Sydney on 10/23/2002 06:41:00 AM 0 comments 0 Comments: |
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