My first thoughts about health care go back about 29 years when I went to a dentist in California for a toothache. I had signed up for an HMO, which seemed like a great program. Pay a small set fee and everything is covered! Wonderful. The dentist in question was part of that HMO plan and I could only go to a dentist "in plan". After an X-ray revealed that I had swollen sinuses from a sinus infection that was causing the pain in the roots of my teeth I went to a regular doctor - in plan - and after an antibiotic I was good to go. So I decided to take advantage of the plan and schedule a normal dental checkup.
I expected what I had always experienced - that I would sit down in a chair, a dentist would poke and prod at my teeth, they would take some X-rays and if necessary I would return to have a cavity filled - one visit or maybe two. What happened opened my eyes to the realities of what is now a health care mess. First I came in for the checkup. Cha-ching! (More)
As I recall, They did poke and prod at my teeth and they took X-Rays. But I was told I had to make another appointment for the dentist to read the X-rays and for the basic teeth cleaning. So I came back. Cha-ching! I was told I had a cavity. OK. Only then I was told I would have to make another appointment and return again for the filling. Cha-ching, cha-ching! Each visit was no strain on my budget, but the insurance was getting billed for each and every one of them. Little was coming out of my pocket, but my premiums were rather high compared to a more traditional plan.
Then it got worse. I was never a big fan of needles when I was younger, but from the age of 10 or so I always managed to let the dentist do whatever he needed to with sharp objects in my mouth. This HMO dentist was not your normal friendly gentleman. He was impatient, rude and in the process of giving me the novacaine, somehow managed to miss and I could taste the stuff on my tongue. When I squirmed and protested he got angry and had to leave the room. I got a little agitated myself.
I learned two things. When there is a middleman between the service provider and the patient who provides funds without question on the basis of a pre-arranged plan, there is no incentive to be efficient or to control costs. Second I learned that at least some professionals in these programs are not nearly as good as those who had a more traditional practice where the customer has a more significant role in paying for the service and might go somewhere else if the care is less than stellar.
Everybody complains about the cost of health care and the left blames the doctors and they blame the insurance companies without any distinction. Those on the left typically suggest that because health care is so expensive we need to pump more money (taxes) into the system or use a government program to "control costs" which can only mean one thing in a massive bureaucratic system - someone far removed from the patient will make decisions about what services are to be provided. But from my perspective, it is the separation of the doctor-patient relationship in the setting of costs that is the problem, and added bureaucracy will only make it worse - hence since Obamacare costs have risen like many said they would.
Conservatives point to other solutions, which to me make more sense. First, decentralize. Allow price competition across state lines and make providers compete for dollars rather than simply be able to set a price and expect payment. That is a small step but a simple one. Better yet, restore the relationship between the provider and the patient and let prices be set closer to that relationship. Many good medical professionals order that one extra test, not because the patient does not trust him or her, but because of fear that there might be a lawsuit or some other legal issue if something is missed and more importantly because they can bill the insurance company - not the patient. Tort reform, limiting settlements and reducing frivolous lawsuits would help immensely, but again putting doctors and patients in a position to control costs is the biggest step toward fixing things.
Finally, roll back the HMO mentality. There is no reason that every single scratch or scrape needs to be a matter for payment through insurance. If I go see a doctor for a common ailment like a seasonal cough or congestion and the doctor tells me "Yup, there's a bug going around - get some rest, drink lots of fluids and take a decongestant", there is no reason insurance companies need to be involved at all. I'm sure a lot of doctors would be fine to skip all the paperwork, take a small cash payment and be done with it.
Insurance should be for catastrophic health issues. As Anne Coulter correctly points out, we do not expect car insurance to pay for new tires and oil changes. We can take care of the small stuff - just help me out when somebody sideswipes me and totals my only source of transportation. The same can be said for medical, dental and other health care. I need insurance when I have a heart attack or pneumonia. I don't necessarily need a ton of paperwork and claim forms and set prices when I sprain my ankle and need some ice and a pain killer. Somehow the connection between the doctor's actual service provided and the price paid by the patient has to be restored.
...And we definitely do not need a federal program setting prices and determining what services I need and taxing the entire country into bankruptcy to finance it. That is guaranteed to lead to worse care at a higher cost.
No question many people need medical care and can't afford it. But the direction we a heading is not a solution. Costs will go up because local accountability and local decisions will be short-circuited. And rationing will follow - someone in an office looking at statistics and cash flow will decide who gets what care to control the costs. We'll be told what to eat, how much to weigh, how large our drinks can be. We'll all pay for sex change operations, abortions and sterilizations because all procedures will have to be available to all by national policy. And eventually those who need catastrophic care will be denied it based on someone's cost-benefit formula.
Sound familiar?
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