Arnold Kling  

Health Care Spending

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A blogger writes,

Yes, yes, hindsight is 20/20. But the fact that the patient started to improve clinically within about 4 days of her inpatient hospital course (and with that, essentially showed us that she had mono, not lymphoma) makes me wonder if it was all necessary. A cursory PubMed search didn’t turn up much on, say, delaying a possible cancer workup by a week or 5 days (by which time someone with a non-cancer might expect to start to improve). I can’t say whether the extra week does much for survival or quality of life. If a week really dose make a difference, then maybe the $80,000 is worth it—after all, cancer can be fatal if not caught early.

The author of this post is a self-described "health policy activist," who favors single-payer. However, this anecdote would have fit perfectly with the thesis of my book.

Did the patient who ran up this $80,000 bill have too little health insurance?

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COMMENTS (6 to date)
T.R. Elliott writes:

I don't think the problem is too little health insurance. The problem is too much health insurance on one side, and too little on the other. And the nut to crack is to figure out a way for society to ration care on the one end and ensure those without, particularly children, receive some modicum of care on the other end.

Good luck cracking that nut. Those with health insurance have become pampered and lazy by our consumerist "we'll meet all your needs" society. I sat on a plane on the tarmac once, a plane with mechanical problems, next to several people who complained and moaned about the delays. I asked the woman next to me if she wanted to take off in a plane with mechanical problems. She said they should have spare planes. I asked he if she wanted to pay the price for spare planes sitting unused at each and every airport. She had no answer.

And I'm sure some folks are going to complain about my use of the term rationing above. Call it whatever you want. People want to live forever, while willing to get into an automobile every day (big risk) yet want every possible test performed when they have a health problem. And why not?

I say the solution on the one end is to categorize health care delivery according to several delivery models. The all you can eat plan, in which you can pretty much have any test or any drug you want any day of the week. Then make them pay for the cost of that plan. Then other plans based upon certain probabilistic risk factors (cost benefit analysis).

I think it could be done. But the way insurance is currently strongly associated with employment is ridiculous. Health insurance has nothing to do with employment. If so, then why not car insurance with my company. I really think the association between employment and insurance is part of the problem.

T.R. Elliott writes:

Another issue: pre-existing conditions. I can't take my car into a new insurance agent and argue that the smashed front end should be handled by my new insurance policy that I'm negotiating with them. The new policy is future oriented. But there is a moral argument for ensuring a way to handle pre-existing conditions. Otherwise, at worst, we have genetic testing for preconditions. That is not acceptable.

That said, one has to deal with the free riders, but the only way to do that is to make insurance mandatory. And then somehow bundle together certain types coverage to distribute the costs and risks.

Which, interestingly enough, is exactly what Edwards was talking about in the last election cycle. Instead, we get corporate bloated medicare madness from present administration, which is unable to create workable policies and even when they are workable they are oriented towards corporate donors.

Graham writes:

Interesting hypothesis. I was looking forward to reading a few pages of the book on Amazon, but it's not available! Tell your publisher!

Thanks for the link.

Jon writes:

We don't know if it was a true $80,000 workup or that the patient even had insurance.

The way hospitals work, it could have well been an $80,000 bill for which they accept $5000 from an insurance company. The $80,000 is what they would insist an uninsursed patients pays until the medical bills make them indigent.

Timothy writes:

Why not test for mono first? I mean, really?

z writes:

You can test for mono first, but you still need to test for lymphoma if that is suspected. If the mono test comes back positive, that doesn't mean that the patient doesn't have lymphoma, the two aren't mutually exclusive.

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