Why I Choose Low-Quality Health Care
Before the renewed discussions and debates over socialized healthcare begin in earnest, I want to make my preference known to all: I desire low-quality healthcare. All right, to be straightforward, I do not actually desire low-quality healthcare; I simply do not desire high-quality healthcare -- at least not "high-quality healthcare" as defined by generally accepted standards.
Allow government to decide levels of medical risk -- to socialize personal risk -- and healthcare follows the same path of any socialized sector of the economy. This is apodictically true.
We are acting individuals with our own preferences. We are not automatons seeking to conform to an imposed definition of quality. Though the government may appear to be the safe solution, it is the siren enticing us onto the rocks. FULL ARTICLE
Comments (12)
Michael Wilson
This does not directly address your article, but is related: it touches on the intersection of health care, personal liberty, and (potential) government coercion.
Surely a person has the right to refuse medical care for himself, or to cease a course of treatment. I wonder if, in your opinion, this right extends to taking antibiotics; when, doctors say, not completing a course of antibiotics encourages the development of drug-resistant germs, which can sicken others.
Published: November 20, 2008 10:10 AM
greg
For the average person, quality of care should not be the question we should ask as there is really not much difference between the different levels of quality. And when your life is on the line, you want the best.
If you want to get the biggest bang for your buck, you should be making a decission on the structure of your insurance. When you sign up for a policy, you are basically placing a bet with the insurance company about your healthcare future. And just like placing a bet in Las Vegas, the odds are with the company. Furthermore, sick or well, you pay that premium every month whether you write the check or your company pays for it as part of your wage package.
Heathcare facilities have two prices, one for insurance and the other for cash. Typically, the cash price is 50 to 70 percent less than the insurance billed price. Of course, what the insurance company pays is 70 percent less than the billed amount.
Without going through a financial spreadsheet, which I would be happy to do, the most cost effective healthcare plan is to go for a $5,000 family deductable. Pay cash for all expenses up to $5,000 and turn them into the insurance company yourself without going through the doctor's office. And remember, you can negotiate your charges down further.
Now if all policies were written with a $5,000 deductable, you would see a noticable decrease in the cost of medical care as we take everyone that runs to the doctor for every problem. At least it will take those mothers out of the picture that run their children into the doctor with a virus, trying to get antibiodics.
Increased deductables will cost your employer less and they would be free to pay you more per hour. And that is money in your pocket every hour you work. Healthcare benefits is something you get only when you are sick.
Finally, my last point is that if we expand healthcare with low deductables to everyone through the government we will see an increase in healthcare cost to levels 3 times higher than today because of the huge increase in demand for everyone that will want to get their fare share of healthcare. And insurance cost will go up too.
Published: November 20, 2008 10:15 AM
John
As long as people realize that they are getting something they think is free, why not the best? Which usually means most expenseive. If I have the option of a Pinto or a Lexus, I'll always go for the Lexus. I also never agree to splitting restaurant checks; if you want the best, pay for it.
Published: November 20, 2008 12:02 PM
Roger Cooke
So far as any responsible, competent adult goes, making decisions only on his or her own behalf, I agree with the position taken here. But do parents have the right to choose no care or low-quality care when their children's lives are in danger? And at the other end of life, when an aged parent is no longer mentally competent, do those responsible have the right to choose no care or low-quality care? And, as Michael Wilson has suggested above, does the state have no overriding interest in preventing the spread of infection to others? It used to be possible to quarantine those with dangerous infections. That seems to be questionable nowadays (I refer to the SARS-infected man who flew all over the Western World a few years ago).
Published: November 20, 2008 12:34 PM
Fred
You say "Now I have no issue with guidelines or ratings. They provide a means to understand the services that a given physician might provide. They are not perfect, but what is? And, more importantly, they are not mandates from government."
Not quite. I have managed the medical practice of an excellent physician for 25 years. I can tell you those guidelines are not developed by a neutral process: insurance payors are their drivers, and for payors cheap = good.
Keep in mind that the largest payor is the federal government (1/3 of American medical care).
Lest you think organized medicine must represent physicians' professional responsibility to recognize and use only honest guidelines, please be aware that 60% of the American Medical Association's revenue comes from its copyright on the CPT Codes used to record services and bill charges. Why are those codes so popular? Because the federal government requires their use, thus every physician, etc. must purchase yearly publications of the AMA copyrighted CPT Codes. In other words, all the government need do to silence the AMA when it gets too uppity is quietly moot putting the codes out to bid.
BTW, the next big thing is those wonderful electronic medical records, which are again driven by payors. An EMR is in effect a language. If it is constructed to make "cheap" easy to say while "costly but better" is cumbersome and time consuming guess which will tend to be said more, especially by physicians' being paid less per hour than nurses at their local hospital. Not to mention an EMR is easy to snoop through en mass, and by the HIPAA law, is wide open to government snooping on demand. And subject to mass breach: the British National Health Service lost 25 million.
Published: November 20, 2008 3:35 PM
Fred
You say "Now I have no issue with guidelines or ratings. They provide a means to understand the services that a given physician might provide. They are not perfect, but what is? And, more importantly, they are not mandates from government."
Not quite. I have managed the medical practice of an excellent physician for 25 years. I can tell you those guidelines are not developed by a neutral process: insurance payors are their drivers, and for payors cheap = good.
Keep in mind that the largest payor is the federal government (1/3 of American medical care).
Lest you think organized medicine must represent physicians' professional responsibility to recognize and use only honest guidelines, please be aware that 60% of the American Medical Association's revenue comes from its copyright on the CPT Codes used to record services and bill charges. Why are those codes so popular? Because the federal government requires their use, thus every physician, etc. must purchase yearly publications of the AMA copyrighted CPT Codes. In other words, all the government need do to silence the AMA when it gets too uppity is quietly moot putting the codes out to bid.
BTW, the next big thing is those wonderful electronic medical records, which are again driven by payors. An EMR is in effect a language. If it is constructed to make "cheap" easy to say while "costly but better" is cumbersome and time consuming guess which will tend to be said more, especially by physicians' being paid less per hour than nurses at their local hospital. Not to mention an EMR is easy to snoop through en mass, and by the HIPAA law, is wide open to government snooping on demand. And subject to mass breach: the British National Health Service lost 25 million.
Published: November 20, 2008 3:36 PM
lpcowboy
greg,
Fiscally responsible individuals will always be financially better off self-insuring.
Personally, when my life is on the line I don't want the best, I want to be treated cost-effectivley.
Published: November 20, 2008 7:48 PM
D. Saul Weiner
It's not a question of whether or not you want the best treatment for yourself or your family. It is a matter of how is that evaluation going to be made? Will you defer to a committee which has criteria for evaluating treatments that may be quite different from your own? Will you be forced to go along with the opinions of the bureaucrats. Or will you be able to make your own choice, using the recommendations of people whose positions you value, and rejecting the ones you don't buy into?
Published: November 22, 2008 1:29 PM
Chronos
I do have one issue with your article. One of the things that a lot of libertarians are myopic about, and happily one that most Austrians readily acknowledge, is that externalities exist and people sometimes shirk the consequences of their actions, and that such shirking of consequences is a form of force. This is most well known when it comes to air and water pollution, but vaccination is another area where it's also important.
Vaccinations work through a phenomenon known as herd immunity. What's herd immunity? Well, no vaccine offers 100% protection. But if you can immunize enough people, some number that is large yet less than 100% of the population, then the entire population is protected because the disease can't find enough new hosts to create an infectious outbreak.
(Statistical aside: At an individual level the chance of infection is random, but when you add random chances together, the result is always a Gaussian -- this is the reason why rolling two dice and adding their faces is far more likely to result in a 7 than a 2 or 12. At the level of a town or larger, the randomness smooths out into a near-certainty and you can actually quantify it. This is what macroeconomists of the Keynesian and Monetarist schools wrongly believe that they're doing with human action. However, it actually works in epidemiology because disease-causing organisms lack individuality and have uniform behavior.)
The shirking problem here is that the herd immunity threshold, which varies per disease and per vaccine, is normally quite high. For instance, pertussis (whooping cough, which can easily kill infants and toddlers) has a very high threshold of 92-94%. If the immunization rate falls below the herd immunity threshold, not only do unvaccinated people get sick, but the unvaccinated people form a reservoir of infection that's large enough to infect vaccinated people as well -- again, because no vaccine is 100% effective, and a larger reservoir means more interactions between infected and uninfected people. (This has actually happened in Boulder, Colorado, where pertussis is now endemic because parents opted their children out of immunization.) But if you push vaccination rates back above the herd immunity threshold, then the vaccinated individuals form a firebreak that prevents the unvaccinated from infecting each other, disrupting the reservoir of disease.
Even delaying vaccines has an effect on herd immunity. Many diseases are more deadly at younger ages (e.g. pertussis) and thus must be immunized at a younger age. If too many parents wait before vaccinating their kids, the unvaccinated young children spread the disease at the age when it's most deadly. Even if a child is vaccinated yet still becomes ill, vaccinations reduce the intensity of the disease and, more importantly, delay the average age of first infection (by reducing opportunities for infections at a younger age). The existing childhood vaccination schedules save a stupendous number of lives.
(In contrast, other vaccines are actually a bad idea. Varicella a.k.a. chicken pox, for instance. Chicken pox can have complications but is fairly unlikely to kill an otherwise healthy child. However, it's an extremely dangerous and quite deadly disease if you first contract it as an adult, even after a vaccination. As before, vaccines raise the average age of first infection, so varicella vaccine would actually cause more deaths than it prevented unless we could somehow jump straight from "hardly used" to "herd immunity" without an intermediate gap. But realistically that's not going to happen, so giving varicella vaccine to children is a very bad idea.)
Now I'll be the first to admit that you didn't go into details and some or maybe even all of this might be preaching to the choir. If so, my apologies. But there's a lot of anti-vaccination ideas floating around on the web these days, and even if you don't believe in them yourself I worry that your article leaves things open ended enough that the holders of said ideas might take your article as supportive.
Published: November 25, 2008 1:36 PM
Jim Fedako
Chronos,
I hate to answer your questions with questions -- it's bad form. But ...
What is your solution to maintaining herd immunity? Who decides which vaccine is a must and which is not? Who decides the vaccination schedule? Does everyone have to adhere? If so, under what penalty?
None of this is meant as a disclosure of the vaccination schedule we desire. I am just trying to understand how herd immunity coexists with liberty.
Happy Thanksgiving!
Published: November 27, 2008 8:54 AM
Chronos
@Jim Fedako:
No need to apologize, as they're important questions. And the truth is, I'm not sure what the answers are. But I do have thoughts along those lines that might illuminate answers:
Similar to air and water pollution, which infringe on someone else's land rights, refusing to immunize infringes on someone else's right to their own health (or the health of their dependents). So the obvious answer is that, if you choose not to immunize within a libertine community that has chosen to pursue herd immunity, you need to get permission from every other member of the community. This would probably involve payment, from you to them, in order to offset their increased chance of contracting a harmful illness.
Inverting that, to examine what "libertine community that has chosen to pursue" means, we might suppose that all members of the community have signed a contract, agreeing to pursue herd immunity for a particular disease via a particular vaccine. Thus, the costs paid by an individual for not adhering to the immunization schedule are either breach of contract (because the person signed and the reneged on the contract) or the cost of doing business with this community (because they choose to isolate themselves from the individual, through freedom of association, unless he/she compensates them in return by signing the contract or paying the costs).
Is that actually workable for something as large as a city, or even a town? I don't know. But it can clearly coexist with liberty in the abstract, so I think it's a useful line of thought.
Published: November 27, 2008 12:19 PM
Jim Fedako
Chronos --
Yes. Property rights are the solution in theory. But what is the solution in our current system of fluid, ill-defined property rights? This where is gets sticky?
Published: November 27, 2008 10:26 PM