The
problem, specifically, is that patients with insurance
have higher copays and deductibles. According to an article
on Medscape (free registration required):
href="http://www.medscape.com/viewarticle/560983">U.S.
Hospitals Struggle Over Who Can Afford to Pay
By Kim Dixon
CHICAGO (Reuters Life!) Aug 06 - For-profit hospitals, which are
blaming unpaid medical bills for tamping down profits, are struggling
with a simple question: Which patients have the ability to pay their
hospital bills? ...
HMA and LifePoint Hospitals are among the major chains that posted
falling profits in the most recent quarter, largely citing difficulties
in collecting unpaid patient bills.
Most chains' bad debt -- a key gauge of uncollected medical bills -- is
rising and topped 10 percent as a slice of quarterly revenue.
The idea of having patients pay a higher percentage of their health
care costs is a key element of conservative health care reform
proposals. The idea is that it should make them smarter
consumers.
This is a nice illustration of the problem with ideologically-based
reasoning.
Perhaps
the idea sounds promising. It certainly resonates with nice
catch phrases, like "personal responsibility" and "the magic of the
marketplace."
But, catch phrases often do not translate into sound policy.
It order to know what works, you have to try it and see what
happens.
Well, we are trying it, and it is not working.
Empiricism trumps ideology every time.
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The problem is, empiricism will never dent ideology. A sledgehammer between the eyes might, but I'd have to check first to make sure.
Health plans with high deductible push consumers to ration their own health care. Unfortunately, this leads to people making bad and frightening decisions. Most lay people don't know enough medicine to make these decisions--that's why we have doctors. For a 26 year old mother of three to have to decide whether it's worth 100 dollars out of her weekly budget to take her sick kid to the doctor...that's just foolish.
Hopefully, the US will realize the inherent idiocy of such plans--and I think we will, but it will take years.
But perhaps the Law of Unintended Consequences is that it costs so much in time and money to become a smarter consumer that you may as well be a doctor. Ergo, that INVARIABLY leads to bad decisions in health care, which leads to catastrophic problems in far too many cases which leads us to the current situation.
Ah yes, the libertarian myth of the omniscient consumer.
Those that actually have seen medical practice and what it entails realize that treating people like they can be educated consumers in healthcare is idiotic.
For one, it's too complex, requires a great deal of basic knowledge of physiology and biology, and a huge number of people simply will never be able to make good or rational health care choices.
Second, and people rarely appreciate this, doctors are always the worst patients, and should never be responsible for their primary medical care or their family members, which is unethical and problematic. A doctor is more than just a dispenser of drugs and advice, they are also an important outside consultant, independent agent, advocate for patients, etc. People are terrible at managing their own health, and being responsible for something medically unfortunate happening to a family member is a nightmare best avoided. Everyone should have access to a doctor, and no one should be avoiding care for themselves or family because of economic impediments. It increases the overall cost of care by preventing the single most cost effect agent access to patients - the PCP or family doc, and ultimately leads to ER-based primary care, disaster and tragedy.
"The idea of having patients pay a higher percentage of their health care costs is a key element of conservative health care reform proposals. The idea is that it should make them smarter consumers."
Where I live (a small rural town in Minnesota), it won't make much difference to the local clinics whether their consumers have been frightened into being smarter or not. The patients are predominately senior citizens, on fixed retirement incomes and medicare plans. Which also means they're not the ones skipping out on their doctor bills.