The president has been known to enjoy an exquisite steak. Besides exemplifying a two-tier system where the wealthy will always remain at the top of the food chain, what does this have to do with ObamaCare? More than one might think! Along with other failings, it does not control costs or simplify a smorgasbord of providers, services, and redundancies. The legislation neglects to cure shortcomings in a health care system that is nonetheless the envy of the world, while exacerbating its deficiencies by adding layers of bureaucracy.
Let’s put the dilemma in terms even the administration can understand: Buffets come in multiple sizes and cuisines: Chinese, Japanese, Italian, Mexican, Indian, and American; but the one with nearly endless serving stations, the one everyone will eventually partake at is the multi trillion dollar health care buffet. The analogy may not be perfect. Instead of dim sum there is angioplasty. Quadruple bypass supplants sesame chicken. Whether in the conventional or figurative form these all-you-can-eat extravaganzas are characterized by a single underlying common denominator: the universal urge to indulge.
At buffets, food is not purchased a la carte. Instead a one-time fee grants unfettered access, patrons can consume as much food as they choose. Normal market forces of supply and demand are ignored as multiple plates are stuffed with goodies. Price no longer deters excessive consumption. With cost out of the equation many people consume more than they normally would. The restaurant is ok with that. If necessary, the owners can raise the price to clear a profit. The only downside to this gluttony is perhaps a bout of gastroenteritis and bulging waistlines.
The point is fundamentally the same basic motivations drive consumption at both the typical dinner buffet and the health care network. The insurance premium offers similar Carte Blanche access to all the health care carving stations: gastroenterology, cardiology, OB/GYN, pediatrics, etc. Once the initial insurance premium is paid, additional services are essentially free, depending on the policy. Patients may pay a small deductible or token co-pay, like a tip. This nominal fee, however, does not reflect actual cost or value of the service. Thus it does not effectively restrain demand.
Initially, this analysis may seem counterintuitive. Why would someone voluntarily let himself be poked, prodded, injected, forced to strip or be exposed to radiation unnecessarily? Then again, why would someone eat himself sick at our hypothetical buffet?
Over treatment is a major problem in this country, but like at the dinner buffet no one seems to care. Insurance companies can pass cost increases on to employers by raising premiums. Employers absorb this expense in lieu of employee wages. The insured public also turns a blind eye as well. They view it as an employer or insurer expense, and not their own. The deleterious health impact of this over indulgence goes largely undocumented even though it’s far worse than a tummy ache from shoving down a few too many potstickers.
Medical complications range from mild drug reactions to heart attacks, strokes, and even death. Families are destroyed, loved ones are lost. It does happen. Even if statistics cite a small one half percent risk for a particular procedure, for the individual who succumbs to an adverse event, it is one hundred percent.
All lines in the health care buffet lead to over treatment. For this there is plenty of blame to go around. Patients have an insatiable appetite for health care. They seek a quick fix, the newest medications and the most technological treatment. They certainly don’t want a provider to echo their mother’s recommendations: two aspirin and a hot bath. Doctors are often pressured by patients for both prescriptions and specialty referrals. Additionally doctors must always be wary of potential malpractice claims. As a result, the country wastes billions of dollars annually on excessive medical care. Yet more treatment does not guarantee better treatment, just more side effects.
It is unlikely the bill President Obama recently signed into law is the answer. It is a step towards a single-payer system. Long waits, limited access, and rationing have been documented wherever this experiment has been implemented. While diminished opportunity to pig out is a good thing, Americans, will reject this low calorie diet. Furthermore, the government’s record of delivering services and controlling cost on the taxpayers dime to over eighty million people currently receiving mandated care through Medicare, Medicaid and the military is available for all to see. Already with tens of trillions of dollars in unfunded liabilities, it’s not a pretty site.
The 2,700-plus pages of ObamaCare may eventually swap the lavish buffet with a stingy starvation diet dolled out by some rigid, heartless bureaucrat. While health care consumption needs to be controlled, more sensible, patient friendly solutions exist. Along with malpractice reform, low premium high deductible insurance policies are needed to give patients a “dog in the fight” and insure that they are not mere third wheels on the provider-insurer-patient axis. Currently the primary nexus is between the insurance company and the provider. This often leaves the patient as the odd man out. The tax code needs to encourage individuals to purchase policies. Insurance coverage needs to become more portable and available nationally to foster competition among carriers, thereby lowering cost. Health Savings Accounts should be expanded and simplified. There must be a learning curve promoting the notion that more treatment does not equate to better treatment.
To solve any difficult dilemma one must first clearly define the issues. There are solutions to the medical quagmire, but proceeding beyond the appetizers and on to the main course will first require an accurate objective grasp of the real problems.
Bon appetit.
Jason D. Fodeman, M.D. is an internal-medicine resident at the University of Connecticut. A former health-policy fellow at the Heritage Foundation, he is the author of How to Destroy a Village: What the Clintons Taught a Seventeen Year Old