Monday, June 1, 2009


1. You should take personal responsibility for your health.  To encourage people to do this, make people pay less insurance and more out-of-pocket.

2. Constant bombardment of ads and culture to not take chances with your health.  "Ask your doctor about..."

I find it saddening, sickening, sobering, that the conservative argument that the way to encourage people to take more responsibility for their health is to communicate via price.  The thinking is this will make people use less healthcare, thereby saving money.  Perhaps.  But ONLY when they don't have a choice.  Yes?  This will limit healthcare consumed by poor people, uninsured, and under-insured. 

Ultimately, the effect is to push decision-making onto the patient, who must balance her health against her wallet.  HOWEVER, that patient is typically NOT in a position naturally suited to clear-headed balancing of the costs and benefits of a particular (health) expenditure.  And doctors do not communicate price, for which I can think of two definite reasons: first, it's base and disgusting to tell a patient they might need a procedure of some sort, a test, and then immediately discourage your own recommendation by telling them it costs a lot of money.  Second, it is in the doctor's financial self-interest to not communicate this clearly.  The more healthcare you consume, the more they get paid. 

That's a perverse incentive.  We don't want to encourage the consumption of healthcare, we want to encourage better health.  But that's a whole other line of thought.

My final thought on this matter is that we need to decouple "personal responsibility" from $$$.  A person should be involved in their own health, I fully grant the validity of this.  But price is a distraction.  We should make it easier to get involved, we should incent doctors to involve patients (ie, stop making me pay $15 or $20 every time I go to the doctor just to get a copy of my chart!), we should encourage a collaboration between patient and doctor that emphasizes expert advice on what procedures are needed.  We should not think that just because something costs more and I will automatically make a better decision about it.  No.  What I will do is use less of it, depending on my income.

Talk about class-ist.

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