Tuesday, August 04, 2009

Best health care system in the world (as long as you're healthy)

It dawned on me today that the reason so many people support the current health care system in the U.S. is that it actually works pretty well as long as you don't actually need any care , which is true for most of the people most of the time.

In late April, Shelly Andrews-Buta was scheduled to undergo treatment for breast cancer that had spread to her brain, threatening her life.
But instead of having doctors working to remove her brain tumors on the day the surgery was scheduled, she sat in a San Francisco hotel room. Why? Because at the last minute, her insurance company, Blue Shield, decided it wasn't going to pay for the treatment her doctors at UCSF Medical Center had recommended.

I've actually had a personal experience with our wonderful health care system recently: I had a small skin lesion that wasn't healing up, so I thought it might be a basal cell carcinoma. My primary care physician referred me to a dermatologist, but the earliest appointment I could get was over a month away.

The fundamental problem with our current system is that it produces a perverse incentive to deny care. For an insurance company, all else being equal, the less care you provide the more money you make. So the insurance companies are strongly incentivized to provide as little care as possible without actually pushing people so far over the edge that they get motivated to change the system (and you can't get much more unmotivated then being dead). Hence the endless repetition of the "best health care system in the world" mantra: if you can convince people that this is true, then agitating for change becomes downright unpatriotic.

It is also ironic that it is exactly the same flawed logic that makes people fall for this con that makes them need insurance to being with: no one thinks they're going to get sick until they actually do. By the time they get into a situation where they really need medical attention and discover firsthand how b0rken the system actually is, it's usually too late for them to do anything about it. Which is, of course, exactly how the insurance companies like it.


stechert said...

The best analysis I've read so far about why we should all be worried about this:


Danston said...

I'm reminded of this sarcastic article: http://www.newsweek.com/id/209817/page/1

Thomas Lindgren said...

The only system I can see where you'd get a more or less immediate appointment is one where you pay cold, hard cash at the counter.

(Speaking as a user of socialized health care, where I have waited about that long to get something with somewhat more gruesome symptoms examined.)

Ron said...

What bothers me about my case is not so much the wait per se, but the fact that it was unconditional. My worst-case scenario is a basal cell carcinoma, which has a pretty good prognosis. But what if I'd been looking at a possible melanoma? A month-long delay in that case could be the difference between life and death. But they didn't even ask; that information was not even an input into the system. They also didn't ask if I'd be willing to pay more to be seen sooner, so that wasn't an option either.

At the moment we have the worst of all possible worlds. We have already have de facto rationing. We already have long waits. The only thing we don't have is a guarantee against capricious rescission. So we have all of the bad aspects of socialized medicine without any of its benefits.

And we have the insurance companies and their Republican puppets-on-a-string going on about how we have the best health care system in the world. And it's true. It is the best health care system in the world -- for the 90%+ of people who don't need health care. But I think that rather misses the point.

BTW, the link that stechert posted above is really excellent.

Dennis Gorelik said...

So, Ron, what is the solution to that (aside of having no health insurances at all and simply pay cash)?

Ron said...

> what is the solution to that

I don't know. It depends on what the underlying cause of the delay is, and I won't know that until I get a chance to talk to the doc. The fix is different depending on whether I'm lined up behind a bunch of melanoma patients, or a bunch of cosmetic surgery candidates.

Dennis Gorelik said...

Most likely case is that you are in line behind patients with real problems.

So, how would you address such case?

Ron said...

> Most likely case is that you are in line behind patients with real problems.

That seems unlikely given that they didn't ask me why I was making an appointment.