In health care, the rich and powerful really aren't insulated
In health care, the rich and powerful really aren't insulated
Princeton economist Uwe Reinhardt wrote a letter to the Wall St. Journal last week, tweaking the Journal for espousing market forces in health care in the form of high-deductible plans. After all, writes Reinhardt, corporate executives often receive generous, lifetime health insurance and are even reimbursed for out-of-pocket expenses. Shouldn't they have "skin in the game," too?
Today the Journal published a thought-provoking response by Matthew Huggins:
Actually, there is more equality in access to health care services than there is for most other things. For example, think about disparities in transportation from Boston to Washington:
Princeton economist Uwe Reinhardt wrote a letter to the Wall St. Journal last week, tweaking the Journal for espousing market forces in health care in the form of high-deductible plans. After all, writes Reinhardt, corporate executives often receive generous, lifetime health insurance and are even reimbursed for out-of-pocket expenses. Shouldn't they have "skin in the game," too?
Today the Journal published a thought-provoking response by Matthew Huggins:
Perhaps the... isolation from the market... makes [corporate executives] ill-suited to oversee the wholesale purchase of health-care services for others. [I]nstead of stripping executives of their... coverage, as Prof. Reinhardt wryly suggests, in furtherance of sounder markets, why not strip them of their predominant role in purchasing health-care services? Reassign such purchasing decisions to individual patients by dismantling the regulations and tax incentives that tend greatly to enhance the relative purchasing power of large employers and governmental bodies.Another letter by Brian Acker pointed out that we don't advocate equality in other sectors, so we shouldn't worry about inequality in health care benefits either.
Actually, there is more equality in access to health care services than there is for most other things. For example, think about disparities in transportation from Boston to Washington:
- Lots of people don't have enough money to go. They stay home.
- Others take the bus
- Some drive --in cars of various levels of comfort
- Some fly coach
- Others fly first class
- Some (like the executives we talked about earlier) go by private jet
- Anyone can go to a top hospital like the Brigham and Women's or Mass General and be treated pretty much the same. You might get hassled by accounting if you don't have insurance, but the doctors and nurses don't tend to give you a hard time based on your economic status
- If you're someone special (e.g., a big donor) you might find yourself on a VIP floor at Mass General (though it's unlikely elsewhere). The room's not that much better, though, and you probably won't receive better care. And I'll go out on a limb and say your chance of having something go wrong due to medical "error" is not much affected by being up there. Maybe you can get access to better or more prominent physicians, but not necessarily. And anyway, do you really know how good or bad they are?
4 Comments:
Any thoughts on why it is commonly believed that the disparities are great in the US?
FWIW, in the community where I work, the immigrant community gets substandard primary care, but that's not quite the same thing that you're arguing.
best,
Flea
Certainly there are differences, they just aren't as stark as the differences in other parts of the economy. The immigrants receiving substandard primary care may live --for example-- in 800 square foot apartments in neighborhoods where it's not totally safe to walk at night. CEOs may live in a 15,000 square foot house in safe neighborhoods and have 3 or 4 other houses for vacation.
I think people focus on the disparities because they equate absence of insurance with absence of care. In addition, there's less acceptance of inequality for things that are considered basic rights.
Patients who aren't well off or who don't have good insurance have more trouble managing their health.
A doctor's visit produces two prescriptions, let's say; one for an antibiotic for the sinus infection, one for a strong decongestant. There may be noncompliance simply because, having paid out of pocket for the doctor visit, the patient may not be able to afford his medications. This is made worse if you have a chronic condition. I have several, and take eight different medications a day. In theory. In practice, I take six; the ones that either make a huge difference in how I function or the ones that don't cost us an entire paycheck for a two-week supply. We regularly defer doctor visits because we simply can't afford a day off work and seventy or eighty dollars to hear, "It'll go away on its own, take some Tylenol."
So what this all means is that when we do go to the doctor or to the hospital that we're sicker, and there's no guarantee we'll be able to afford treatment. The specialist I was supposed to see about my dizzy spells wants a hundred up front. I have to pay the electric bill first.
I think maybe the chief disparity is the fact that a rich person has continuity of primary care by a physician who probably doesn't see that many patients. When a poor person goes to a public clinic, or uses an emergency room for primary care, it's likely to be a different provider every time and things that depend on history may be missed.
Also, the rich person's doctor is likely to have more time for "well, try this and if it's not working out we'll tweak the dosage" kind of stuff, and more likely to take charge of making sure the person comes in for followups.
One more thing, a working poor person is going to have a harder time getting to a doctor's office during the workday to catch something at an early stage and have a good outcome, and if they change jobs a lot and their insurance coverage changes too, the hassle of figuring out where they're covered creates a disincentive to visit while problems are small.
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