Saturday, September 15, 2007

Two Tales Of Healthcare

Just the other day I had to take a friend of mine to the doctor. We hopped in the car and headed off into the country, where my friend's doctor has a quaint local practice in a converted house on a small farm. Quite charming, actually. Arriving at the doctor's, my friend was greeted with a friendly hello from the doctor's staff before being promptly weighed and checked in. We were then escorted to a private waiting room where we waited no more than five minutes for my friend's doctor.

My friend's doctor was personable and professional, asking about my friend's new living arrangements while examining the sores he had recently developed. The doctor's diagnosis was that the sores were a simple bacterial infection, easily treated with antibiotics. The doctor told us that she could have the antibiotics ready in a few minutes, so my friend and I took a brief stroll outside around the office. When we returned, the antibiotics were ready and so was the bill. I cringed, knowing full well how expensive such an efficient, personal, and thorough health care experience could be. I looked at the bill and saw ... $55.00 ... Wait, $55.00? That couldn't be right. The appointment, plus the medicine, with no insurance coverage whatsoever ... only $55.00?

At this point I should probably tell you that my friend is my dog Callahan and his doctor is a vet. Before I say anymore lets get to my other story, which is about a little accident I had a couple of weeks ago. I was slicing a bagel for a late night snack when I accidentally sliced more than just the bagel. Some cursing and bleeding ensued, but while the cursing soon subsided, the bleeding was not so easily dealt with. Even after several hours of bandaging and compressing the cut on my finger still seemed to be oozing blood at a troubling level.

I could have gone to the emergency room or an all night clinic, but I really didn't want to. It was my first day at a new job in the morning and I just didn't want to deal with any hassles or any sleep deprivation. Eventually, after waking up several times during the night to change my bandage, the bleeding subsided. I had taken care of my medical emergency myself, without the help of any professionals. Was I stupid to do so? I don't think so- I was pretty sure that this was a borderline sort of case- not really serious enough to warrant professional attention, but maybe annoying enough to warrant something other than my own incompetence. If it was a child who was cut, I would have gone to a professional ... but for myself, I played the waiting game and I won.

Now what's the point of both of these stories?

In part I just wanted to illustrate how personal health care is to us, whether we're talking about ourselves or those we are responsible for. Our current system of individual health care, quite frankly, just plain sucks. Most Americans are at the mercy of their employers and their health insurance companies because of a terrible tax system and complex array of laws, mandates and directives. When I hear talk of universal or mandated coverage, all I can think about is more bureaucracy and less choice.

I brought up the vet trip because I was struck by how similar, yet how different the vet trip was from my own trips to the doctor's office. The place looked like a people doctor- and the waiting and the doctor exam wasn't all that different. But unlike the people doctor, the vet was inexpensive and they had the antibiotics my dog needed right on hand. And remember now, I say inexpensive because there was no doggie health insurance policy in effect here. Depending on your insurance coverage, if you were to go to the people doctor for a checkup and were given a prescription for antibiotics, your co-pays could add up to $30, $40, even $50, not to mention the extra trip to the pharmacy.

On the drive back from the vets, it occurred to me how pet medicine and pet health care operates completely independently of our people system. The pet health care system isn't dominated by the insurance industry, nor is it burdened with the laws and regulations that people have to deal with. And yet it works, cheaply and efficiently. People get the health care they want for their pets, spending as little or as much as they want to spend. Or in other words, you actually have a functional market.

For whatever reason the health care universalists always tend to leave true choice out of the equation- but just look how important choice is. When I chose not to go to the emergency room for my cut finger, that was a choice I made completely unrelated to specific dollars and cents. In my mind, the cost of being up all night was the deciding factor in my decision to deal with the problem myself. In any sort of a shared pool system, the do-it-your-selfers like me will be subsidizing the hypersensitive who would have rushed to a professional at the first sight of blood. Is this really fair or efficient?

More importantly, in a universal system, my neglecting the dollars and cents aspect of the equation would become the norm for all health care decisions- not just semi-emergencies, but any health related decision. And the problem with that is you will have effectively eliminated any meaningful, functional price structure. And without a functioning price system, how can resources really be allocated efficiently?

I realize this is sort of a roundabout way of making my point, but just keep in mind that a health care system (as opposed to a health care market) demands answers and specifics. A market doesn't care whether or not you chose to see a professional at 11:00 at night for your cut- the market will just determine the cost of your choices based upon the choices of other health consumers and the choices of health care providers. But a health care system needs to know whether such a trip to a professional is necessary- whatever that means. A health care market allows Mr. Paranoid to have as many cancer screenings as he wants so long as he can pay for them - but a health care system (whether it be a single payer system or coverage by private insurance companies) makes determinations in order to determine what is necessary or reasonable.

Markets mean choices and while I'm amazed by the lack of choice in our current health care system, I'm even more amazed that most proposed health care solutions would lead to even fewer choices.


Post a Comment

<< Home