TW: Bernstein from NYT shares a personal health care experience to frame some of the challenges with health care costs. Bernstein provides the context, then gets into a fair amount discussion about why the bill is so high in his particular instance. Bernstein's context to me, however, frames some of the fundamental attributes of why our health care system's costs are rising inexorably.
The son was examined by a GP who detected a heart murmur, the GP realized the murmur was neither particularly unusual nor likely problematical. Yet the GP suggested the additional test requiring a very expensive cardiologist. At the end of the day Bernstein, who has good insurance, paid nothing directly out-of-pocket and "considers the money well-spent".
This example displays our system's inability or unwillingness to assume risk. This problem with risk is heightened when the costs of mitigating any such risk is borne in the most indirect ways. Presumably most parents, siblings, children, loved ones of any sort etc. are going to consume almost limitless care if they perceive any risk reduction without having to bear the costs except in the most indirect ways. Furthermore, the care givers exposed to potential litigation and loved ones with minimal risk tolerances will certainly act to meet those demands. Especially if the profit cycle of the care givers is served by this overall risk elimination process.
To me health care reform must address risk. Consumers must be willing to assume some risk. Else we can digitize, privatize or economize to our hearts content but at the end of the day the costs will continue to escalate, inequities grow while overall health care will barely improve.
From NYT:
"The bill was $2,306.88; or, put more accurately, the bill was $2,848.00, but $2,306.88 was the amount my insurance company paid my son’s pediatric cardiologist. So large a bill and only slightly smaller payment for a pretty modest medical service seemed a micro-illustration of the reason per capita health care costs in this country are twice what they are in Germany or the Netherlands, where health care coverage is universal.
First, the situation: during a routine exam, the pediatrician detected a slight heart murmur in our 7-year-old. “Probably nothing; heart murmurs are very common in young children,” he said. “But I’d suggest you see a pediatric cardiologist just to be sure.” So we saw a cardiologist who listened to the boy’s heart for a couple of minutes, then sent him to a technician for an ultrasound, which took about 10 or 12 minutes. Then the cardiologist appeared for about one minute more to look at the ultrasound images, before pronouncing my son problem-free — good news indeed!
A satisfactory arrangement all in all, especially given that, being a person covered by a good health insurance plan, my out of pocket costs were zero (though I do contribute to my family’s health insurance costs to the tune of about $1,400 a month).
...Did my son, for example, really need a $2,300 heart exam, absent any other sign, besides his slight murmur, that there was anything wrong with him?
Perhaps as a national policy it would have made sense for him not to be seen by an expensive cardiologist. But obviously my wife and I wanted to be sure nothing was wrong, and for us that $2,300, paid by our insurance company, was money well spent."
http://www.nytimes.com/2009/04/23/us/23iht-letter.html?scp=1&sq=letter%20from%20america&st=cse
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