Monday, June 20, 2005

Excessive medical care

The Becker-Posner Blog weighs in on Walmart and Employee Health Insurance, both agreeing with Becker's comment that:
co-payments should be required from employees since otherwise they have a strong incentive to use excessive medical care

"Excessive medical care" is never clearly defined. The argument is that co-pays reduce this "excess," thus saving money for insurers and the employers who pay them.

Ms. TfK's father works for a world-famous medical facility. Because he works there, she gets her checkups from the same people who care for Saudi princes, etc. She pointed out that, for most people, that would be excessive medical care.

But setting aside the existence of these famous hospitals and clinics and the fact that a general practitioner in the neighborhood can probably do just as good a physical exam, what else qualifies?

Another way to ask this is "If everyone had free health care, what would change?"

The first thing is that everyone would probably get a checkup every year, maybe every six months. Maybe people would see a doctor every time they got a 24-hour flu (almost always food poisoning). Maybe they'd drop in with every sniffle. I guess those would be excessive.

But we want people to get a checkup once a year. That's how you practice "preventive medicine" and its how we save money and lives. If every woman had a pap smear once a year, we'd catch more cancers at a treatable stage. We'd catch more colon cancer before it spread, people would ask about more melanomas before they metastasized.

Guys would have a chance to ask about that back pain, and get some advice on how to prevent serious, long-term damage.

Doctors would get a better sense of each patient, and would be better able to assess the need for expensive tests.

Right now, we have a system where people with insurance are punished for going in and getting their little aches and pains looked at. Co-pays mean that you pay a little bit every time you see a doctor. That gives you an incentive to let something develop. That will always make it more expensive to treat.

So we have some costs and some benefits.

Benefits: Early detection of cancers and chronic diseases will save lives and can make them cheaper to treat.

Costs: Hypochondriacs will run wild.

The solution seems not to be making people pay more, it seems to be finding a way of separating hypochondriacs from the truly ill. And as doctors will see patients more often, that task will be easier.

So where's the excess?

I have more to say, but this is long enough.

I'm Sick (Of This American Life)” by They Might Be Giants from the album They Got Lost (2002, 1:27).