Friday, December 28, 2007

Avarice and Health

Many bloggers are discussing the nature of people going into extreme debt at this time of year – procuring expensive electronic items with little to no argument about the cost. It is, of course, only natural to make the connection between the money spent on frivolous expenditures while we wring our hands over what to do about the poor and healthcare. What must be seen, if you haven’t already seen the absurd juxtaposition is this: these same people, who spend several hundreds to thousands of dollars for one day’s avarice are the exact same who bemoan the cost of healthcare and villify the physician.

Personally I have changing views on the subject. I used to believe that universal coverage was the best option – in effect, socialized medicine. Then I began reading about the Canadian and the NHS, their troubles, and realized that, even though their citizens are covered, they had harder times getting people to use the system correctly, providers throughout all spectrums were incredibly taxed to work "within" the system, and the outcomes were not much improved. Now I find myself less inclined towards universal healthcare, but struggling to find a plan that makes the most sense.

I do know that some of the political ideas of taxing physicians in order to help cover healthcare for the poor are just monstrously ignorant. Why should those who have to suffer direct losses from this patient population be forced to incur further decompensation simply because of their profession? Do we honestly expect doctors, the one profession that has little to no say in what they receive in reimbursement, to keep allowing insurance companies to decrease their payments precipitously while, at the same time begin taxing them for indigent populations for whom they've never received compensation? Would lawyers be so willing, I wonder, to take hits in the same respect as that offered by some of their colleagues? We all know the answer to that.

The idea of requisite health insurance seems more on the right track. We require people to have car insurance based on the degree of risk inherent with owning an automobile, so why not coverage for their health needs? Certainly people realize that at one time or another they’ll need the healthcare industry – either for minor ailments or severe conditions – and should be more capable of contributing towards their care. We are, as humans, inherently at risk each and every day.

Making people comprehend that they are responsible for covering their asses won’t be easy though. Massachussets has had significant backlash regarding their plan, some due to the significant cost of covering oneself, but a great deal from the parasitic nature of lower income and young populations. The idea of having to pay for something that one might never use has been routinely touted as a justifiable reason to avoid insurance mandates by those refusing to buy into the idea.

Despite the problems encountered by Massachussets, I feel its ideals are on the right track – shifting the responsibility onto those who are actually culpable for their actions and less on those who just have to deal with them. People are so eager to get the newest cell phone accessory, iPod, or fanciest TV regardless of their income level, but refuse to spend a few bucks each week towards their healthcare. Cigarettes continue to increase in price, yet the 1+ pack per day smoker doesn’t cut down on their habit, just their luxuries – like bills and responsible spending. I cannot count the numerous times I’ve seen someone with little to no insurance, complaining about the cost of their care, with a fancy cell phone, cigarettes, and a tricked out car who inevitably heads to the nearest fast food chain for lunch. It’s actually quite ironic to consider that the money spent on these gadgets and behaviors actually decreases one’s health (cancer, hearing loss, obesity, HTN, heart disease, etc.).

While I certainly don’t have the answer, I do feel socialized medicine is not the option that’s best for this country. As a 4th year medical student, it’s hard for me to even begin to understand the complexities of payments, billing, and the business of medical care, but I have been able to gather enough information to understand socialized medicine will only fail patients and providers together.


forHealth said...

It is interesting that you say that doctors have no choice in their reimbursement. The truth is they do. If doctors were brave enough to say "No!" to the insurance companies, fundamental change could take effect. I am talking about doctor's refusing to accept insurance and instead require direct payment from patients. Sure, there will always be those who can't pay the entire bill up front, but you could work out a payment plan on an individual basis. Many doctors bill insurance companies as a courtesy to their patients, but here is no law (that I am aware of) that requires them to do so. Throw the burden of reimbursement back on the patients who choose to carry such ridiculous plans in the first place.

How do you intend to treat patients who have no insurance through no fault of their own? I have tried to find a plan I can afford - even forgoing a few luxuries in life - and not one insurance company would offer me a plan that wasn't less than 50% of my income (some denied me outright). So now I am vilified if I have an MP3 player or watch cable tv. Those product makers were willing to take my money, the insurance companies were not. And lest you think I am completely irresponsible, I put my "premium" money away each month in a savings account for health care because I have NO other option.

MedStudentGod (MSG) said...

I'm actually going to talk about something similar to docs opting out of insurances and basically going on "retainer" in another post.

Part of the problem with insurance companies is that they cost too much. If we're going to have people required to carry insurance then the companies *must* provide cost effective alternatives. I also plan on discussing this topic at another time as well.

MedStudentGod (MSG) said...
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