tag:blogger.com,1999:blog-2308282620289958037.post5166061508524398496..comments2023-08-08T08:41:19.586-04:00Comments on The Medical Contrarian: You'll shoot your eye out!The Medical Contrarianhttp://www.blogger.com/profile/09240492315542223258noreply@blogger.comBlogger2125tag:blogger.com,1999:blog-2308282620289958037.post-20352844982086395612012-02-11T09:52:51.070-05:002012-02-11T09:52:51.070-05:00Insurance is the right financial tool for someone ...Insurance is the right financial tool for someone to use when they are faced with unexpected and catastrophic health issues and insurance would be much more affordable if it were not used to pay for more mundane health costs. Most health care encounters happen under mundane circumstances and insuring the predictable and non-catastrophic serves only to make it more expensive. While the justification for such a financial arrangement is to make things more affordable, the subsidy that is the portion paid by insurance quickly gets factored into the pricing and gets converted to waste.<br /><br />Your circumstances where you were diagnosed with cancer and became acutely and gravely ill is EXACTLY where insurance should be used. However, it requires that prudent people purchase insurance when they are not well and assume under the best of circumstances they will not get anything in return except the reassurance that if they get ill, they will be protected from financial calamity. There will be some people would make unwise decisions in that they would take the risk and not purchase insurance to cover low frequency but catastrophic costs and they will find themselves at the mercy of strangers. People make bad decisions all of the time and it is not the role of the state to step in and insulate them from the consequences. To make that a policy is a really bad idea since it blurs the distinction between good and bad decisions. The economists call this moral hazard. When we subsidize those who are not prudent at the expense of those who are, everyone behaves imprudently. <br /><br />You are absolutely correct about the greater difficulty to detect failure in the health care world. There is a huge push in integrated health care systems to create metrics to measure quality and conversely detect the lack thereof. For major outcomes (life and death), these systems are in place. For the more mundane outcomes, particularly in non-hospital settings, there is a long way to go. The reality is the default metric is patient satisfaction. Thus the responsibility for assessing quality falls back on the patient and resembles the same measures of success and failure used by entities like Amazon or Target.The Medical Contrarianhttps://www.blogger.com/profile/09240492315542223258noreply@blogger.comtag:blogger.com,1999:blog-2308282620289958037.post-78780201689351515502012-02-10T18:03:33.888-05:002012-02-10T18:03:33.888-05:00One of the issues behind the market not working is...One of the issues behind the market not working is in terms of what we as a society can stomach. We can bear to say if you don't have money to fix your brakes stay home or take the bus. But many (most?) of us would have a hard time saying if you don't have money to treat your cancer, lie down and die. Early on in my life when I was acutely ill, there was no way I could have paid for the money needed to save me. I am glad that no one stood next to me as I plunged into septicemia checking my credit status. There is a second issue here. The airlines have a deep interest in being sure that the mechanic does his/her job. A larger (and deeper pocketed) entity has much to lose if substandard care is delivered. If doctors want to work as employees of large organizations, then oversight would default to the organization with the deepest interest in maintaing the integrity of its product. Yes, the individual mechanic would go bankrupt if he is terrible at his job (or her), but much as I respect my mechanic his job is not as hard as the job of the physician, and consequently, the ability to detect failure is not as hard either.Anonymousnoreply@blogger.com