eliminating "overuse"

Suppose you went to your doctor, and he determined there was a small but real chance that you had a serious condition which could only be ruled out with an expensive test.  Would you get the test?

In our current healthcare model, you probably would.  Your share of the cost is probably a small co-pay, typically $200 or less, with the bulk of the bill being borne by your insurance company.

After adding up all of the people who undergo these procedures, and seeing how many of them come back negative, such tests have come to be known as "overuse."  Basically, if our system didn't expend so many resources on improbabilities, then more resources would be available for people whose needs are more certain.

Curiously, this is about as far as the common ground goes, with respect to overuse.  Beyond that, liberals and conservatives agree on very little. 

You see, the left considers a diagnostic procedure "unnecessary" if it only detects an illness occasionally.  In retrospect, we've given the test to a lot of people, and only a few actually had the disease.  We agree that the test didn't find many illnesses.  If we look at it in terms of all the people who took the test and found nothing, then the loss is an inefficiency; waste. 

But if we look at the same problem in terms of the few people who took the test and discovered a significant medical condition, then the procedure is not a waste, it is merely expensive.  Especially when you consider all of the negative results as part of the cost the system as a whole pays to find the small minority who are actually sick.

What's important here is that the accuracy of the test is not in dispute.  The test is not considered "unnecessary" because it doesn't work, but rather because the odds are so low that you have the associated condition.  After all, if the procedure didn't actually have medical merit, insurance companies wouldn't pay for it.

And the conflict is not between people who test negative for an unlikely condition and people who test positive for it.  No, the conflict is between expending resources on people who pay for insurance and might have an unlikely illness, and expending them on people without insurance who have definite needs.  The fact that the left calls the procedure "unnecessary" should tell you how they plan to resolve the conflict.

Of course, with a sufficiently high co-pay people could decide for themselves whether to spend money on expensive, improbable diagnoses.  Liberals point out that individuals aren't very good at making these kinds of decisions -- but isn't that the whole point of going to doctors?

The false choice that's presented is a choice between a situation where some people get "unnecessary" tests and routine care while other people get no care at all, and an alternative where everybody gets only "necessary" treatment by simply reallocating the resources that would otherwise be "wasted" on "unnecessary" procedures.

The real choice is between a situation where those who pay for care get better treatment than those who do not, and a situation where expensive care is eliminated for the majority in favor of inferior care for all.  Aside from the long lines, noticing the difference will depend on whether you fall into that small minority who would have benefited from an expensive "unnecessary" procedure -- but who will no longer receive it.

And that doesn't apply to everybody, of course, because the rich and powerful will always have money to "waste" on luxuries like "unnecessary" tests.  Which is pretty funny, because while you're being told that "the rich" will bear any additional costs of this new system, they're not the ones who are going to be waiting in lines and forgoing expensive treatment.  I don't know about you, but that sure sounds like you're going to be paying a cost to me.

You see, it all comes down to "tough decisions."  Determining "necessity," it turns out, is a "tough decision" that you, your doctor and your insurance company apparently cannot make together.  Fortunately, there are some people who just happened to get more votes than other people -- and therefore they qualify to make those tough decisions for you.  Or so they would have us believe.

Now if only we could get them to bear the costs of their mistakes, huh?  But you can bet they're going to leave that burden on you.

That's the John Galt Line.

Comments

[MaryAlice Nelson]

Ever watch the TV drama "House" the talented staff play 20 questions (tests) to discover the cause of the patient's obscure but real problem. Interesting entertainment - until you start to add up the cost of the numerous, blind alley and maybe helpful tests, exams and procedures.
Worth it? If you are the guy paying for all of it and aren't the one who is sick, the answer isn't so easy.

[John Galt]

Well, MaryAlice, we're probably more in agreement than you realize.

First, ideally I don't believe anyone should be "the guy paying for all of it" for anyone else. And that's good, because nobody should be advocating inferior medicine for other people in order to save themselves money.

But what you forgot to mention about House is that they almost always save the patient. So when we decide this test or that one is too expensive, we're really saying is "Let him die. He's not worth that much."

Your line of reasoning strikes me as inconsistent with why the patient probably bought insurance in the first place: He's expecting care so costly that he wouldn't reasonably be able to afford it on his own. That's why people buy insurance.

So no, I have no problem giving someone expensive care as long as he's paying for his own policy. I'd have more of a problem if we didn't.

What I do have a problem with is that you can't buy a cheaper policy with less coverage because government requires certain things to be covered.

And I have a really big problem telling everybody the care will be just as good in a "reformed" healthcare system, when you've just demonstrated that some people -- like the patients on House -- are going to die. That strikes me as nothing less than dishonest.