When Republicans talk about their plans for health-care, they are talking about people like me. My insurance plan has an extremely high deductible ($5000) which discourages me from excess “consumption” of health care resources. (This is known as the “moral hazard” effect, which economists use to describe the fact that insurance can change the behavior of the person being insured. If I know my doctor visits are free, I’ll visit my doctor more.) Even preventative measures (like regular checkups) cost me lots of money. I don’t have health insurance so much as I have catastrophe insurance.
So why do I bother? For starters, my insurance is tax deductible. Secondly, it isn’t that much money: I pay about $85 a month for a little peace of mind. I don’t expect to get a brain tumor, or cut off a finger, or poke out my eye, but if I did, the injury wouldn’t bankrupt me.
And if this was the whole story, I think the Republican health care plan might have a chance of working. But here’s the rub: I can’t find a primary care doctor. No physician within 40 miles of my home is taking new patients. I want to give them my money, but they won’t accept it. Something has gone very wrong with the health care market, and curbing consumption isn’t the answer.
As the Boston Globe reported yesterday, this isn’t just a rural problem:
A majority of primary care physicians at Boston’s top-tier teaching hospitals no longer accept new patients, putting them in the uncomfortable position of turning away people and leaving members of the public frustrated.
“There is a huge crisis in primary care right now,” said Dr. Sherry Haydock, the medical director of Internal Medicine Associates, a primary care practice at Massachusetts General.
It’s now clear that our health care market is a broken marketplace. The insurance companies and their plethora of paperwork discourage people from becoming primary care physicians, which is what we need more of. (In other words, supply is contradicting demand.) Instead, we are seeing a rush of new doctors to specialties that don’t deal with insurance, like dermatology and cosmetic surgery. We are even seeing some primary care physicians refuse to take insurance all together. Our system is growing more unequal by the day. The rich get access to the finest health care system in the world, and the working poor like me can’t even get a doctor, even if we have basic insurance.
So this is why I’m skeptical of health care fixes that see excess consumption as the big problem to be solved. For me, the problem is that I can’t find a way to consume anything at all.