Sunday, March 21. 2010
Once again, my life has conspired to give me a real-world example of how consumer-driven healthcare saves money.
At five o'clock on a sunny spring Friday afternoon, my six-year-old begged me to go outside and ride Razor scooters. We went to the top of our enormous hill (wearing helmets and biking gloves, or course) and came speeding down again. Right at the end of the ride, as I was stepping on the brakes to come to a stop, I found the scooter wasn't slowing down. I pressed down harder, and suddenly the whole scooter kicked out from under me to the side. I flopped sidewise and landed smack on the pavement. I sat up, feeling a little stunned but not too bad. "Am I hurt?" I ask Malcolm. "You're bleeding!" he shouts. I looked down and saw quarter-size drops of blood on my jeans and gloves. I walked about twenty yards into the house and look in the bathroom mirror. My left cheek is covered with blood. After gently wiping it away, though, I find I have only one injury: a cut under my left eye, about an inch long. Later on I figured out that the cut had come from the edge of my rimless glasses.
I wrapped ice in a wet washcloth and held it on my face while I contemplated what to do. My wife Janet, juggling an infant and two other sons, called a neighbor to drive me into the emergency room. I briefly considered going to an urgent care clinic, but at that point I wasn't quite sure what I was going to need. I figured I'd be better off going to the emergency room, in case the cut called for a plastic surgeon.
I sat for three hours in various waiting rooms at UNC Hospital, ice clutched to my face. After the first two hours I decided that I wasn't concussed and hadn't broken anything, and I started to wonder if I'd made the right decision to come here. After a few text messages to my wife, I found out I didn't have any other option; all the urgent care clinics closed at 8 pm. I paged my regular physician, who advised me to stay put; "Since it's your face, you're probably in the best possible place." Ok. Fine.
After another hour in the examining room, the doctor finally arrived: a young, calm, conscientious resident. I had had lots of time to prepare my speech. "Hi!" I said. "I'm really, really glad to see you. Before we get started, though, I have one small request. I have a high-deductible insurance plan. That means everything you do for me tonight, I will be paying for entirely out-of-pocket. So, as you do your work, I would appreciate it if you tell me what services I can expect to be billed for, and what they might cost, if you know." The doctor was very sympathetic: "To be honest, I know absolutely nothing about what you will be charged. I just write down what I do, and someone else figures out the charges. But I will keep that in mind as we discuss your options for treatment."
I was very glad we started with that conversation, because here's what the doctor said next after examining me: "Because you have a laceration on your face, ordinarily we would call in the 'face team,' which would include a plastic surgeon as well as an experienced EMD. However, looking at that cut, I can tell it's really clean and would come together with just two or three sutures. I could do that for you right now."
"In your professional opinion," I asked, "How much difference would there be between you doing the stitching, and what the 'face team' would do?"
The doctor shrugged. "Not much . . . none, really."
"Ok, then! Stitch me up!" It only took about 20 minutes for him to do the job. There was no mirror in the examining room, but he led me to a bathroom around the corner so I could look at his work. As promised, the wound was closed completely, with three sutures. A nurse gave me a tentanus shot and I walked out, a satisfied customer.
What are the morals of this story?
Tuesday, March 2. 2010
Now that the health care reform debate has gone into overtime, I feel like I need to make one more last-ditch argument. Fortunately, at least one person has made all my arguments for me: David Goldhill's cover story in the September 2009 issue of The Atlantic ("How American Healthcare Killed My Father") says practically everything that needs to be said.
Goldhill is extremely forthright with his motivations, which I especially like – he lets you know right away that his study of healthcare is the result of seeing his father die of a preventable hospital-borne infection. But despite the personal tragedy, his article is remarkably free of emotional charge. He doesn't attack anyone, or blame anyone, but rather lets his critique rush unerringly to the glaring absurdities of the business structure of American medicine:
Goldhill's entire analysis would fit nicely into one of the Freakonomics books, since he is merely pointing out what Levitt and Dubner took as the central thesis of their pop-econ books: "People respond to incentives." Everything that has happened to American healthcare is clearly the consequence of distorted economic incentives. From this perspective, it should be clear that ObamaCare will only give us more of the same distorted incentives, cementing in place the illusion that "someone else" is paying for our healthcare, while letting the healthcare beast continue to devour our national economy.
Goldhill's article is refreshingly full of common sense, especially when you compare it to other popular studies of American healthcare, like Atul Gawande's high-profile article in the New Yorker ("The Cost Conundrum", June 1, 2009) which Obama publically praised. Gawande confronted overwhelming evidence that high costs of health care were driven by doctors' and hospitals' financial incentives to overtreat and overcharge . . . and still he is utterly dismissive of the power of competition. "Any plan that relies on the sheep to negotiate with the wolves is doomed to failure," he quotes one doctor. I see it as a sign of doctors' arrogance that they find it impossible to think of themselves as a commodity that can be shopped. Consumers might not "haggle over the price as if he were selling a rug in a souk," as Gawande puts it . . . but if a hospital down the road offers the same surgery for $20,000 less, don't you think that's going to influence the patient's choice? Especially if it's $20,000 of the patient's own money?
Gawande had another New Yorker article ("Testing, Testing", December 14, 2009) that compared the healthcare industry to agriculture, and suggested that healthcare might undergo a revolutionary change similar to the "green revolution" through government sponsored experimentation similar to what the USDA did for farms. The article was a lengthy apology for the Democratic health reform proposal, which did not have a clear plan for cutting costs but did have lots of pilot programs that would hopefully find new ways to cut costs. I find it utterly disingenuous to suggest ObamaCare is a set of experiments, when the core elements of the plan – guaranteed issue, mandated levels of coverage, wimpy personal mandates – have already been tried in several states, and were colossal failures in every instance, driving up costs and exhausting state budgets, while hardly making a dent in the number of uninsured. You can't position yourself as an experimenter when you ignore the results of the experiments.
Speaking of experiments, I have run the high-deductible insurance and Health Savings Account experiment for myself and my family . . . and it works. I protect myself from debilitating debt from medical emergencies, but I also function as a smart consumer. I spend half of what I used to on insurance, and lower overall medical costs by at least 20% by questioning bills, tests, and procedures. And all of it – insurance and medical costs – could be entirely covered by my FICA taxes, if the government only let me keep that money.
(Page 1 of 1, totaling 2 entries)
Syndicate This Blog