Meanwhile, if you look at our housing system, you'll see that some people get shelter in downtown apartments convenient to the glitz of the big city and some live in suburban sprawl far away from the noisy traffic. Others live in massive gated homes with hired help. All of the homes keep people dry at night but some are more comfortable, some are larger and some are closer to the action.
Americans are different and want choices to live their lives in their own way. Whether it's deciding what to drive, where to work or what to eat, they do things how they want to. Healthcare should be no different.
Let's say that three people work at comparable jobs. Andy might love to travel so he'll live in an apartment for 50 weeks out of the year and eat cheerios and hot dogs so that he can live like a king for two weeks in Europe. Beth, though, might eat out three times a week and hit the hottest clubs on the weekend but never travel outside her city. Meanwhile, Chad could put his money in the stock market and retire ten years before Andy or Beth. All three recognize that they have finite resources and they allocate them in different ways. In other words: to each, their own.
Healthcare, though, seems to be an enigma. Politicians portray it in binary - either you have it or you don't. In practice, that's about what it is. Sure, you have some choice about what you're getting, but you have two general options: either get cared for or get nothing. There's no "lite" version and no "limited edition" to choose from. It's strange that Americans who can choose between six different qualities of ketchup don't get the choice between different qualities of anesthesia. Either you're in and you get the best of the best or you're out and you get nothing. Part of this comes from the modern approach to medicine with "standards of care" and "best practices" and some of it comes from the insurance approach to mandated risk sharing.
If you want to get from point A to point B on a highway, you get a vehicle and go. If you want comfort you might choose a Lexus or if price is more of a concern you might choose a Focus. Of course, you also might choose a noisy Harley or a Corvette with rock hard suspension. The latter two won't provide you the comfort of a the former two, but they will provide other things. In healthcare, though, you typically get just a few options such as surgery or pills. Which surgery is decided by your doctor and the way tha it is performed is perscribed by your hosptial. You can't elect to use the same anesthesia methods used in 2003 (out of style) or the surgery bed from 1999 (out dated). If you get the surgery, you're getting top-of-the-line, no-expense-spared surgery - there's no "best care circa 1995 (at half the cost)" option. If you get the pills, you might be able to choose between brand name or generic, but that's about the only choice in quality you get in healthcare. Thanks to the fear of lawsuites constantly changing standards of care and the notion that the best care is the only option, ignoring expense, you actually have very few options with your health. You get the best, or you don't get anything.
The insurance companies aren't helping. Their goal isn't to give you the lowest price, it's to offer a competitive price compared to other companies. There's no Wal-Mart among them. The insurance companies are all about risk sharing and if people are willing to pay their prices to share risk, they have no reason to lower them. Also, since they are risk sharing, they don't care what the bottom line is, as long as the top line is above it. There's no discount insurance agency competing with the top-end ones, so you either pay the big prices or go without.
Gradations of Care
The answer to this is that medicine needs to be like every other aspect of life. There needs to be gradations of care available with gradations of price. People need to be able to purchase what they need at the price they can afford. Some people can't afford to shop at Dolce & Gabanna, but they can afford to buy their clothes at Target, so while they might not reach the pinnacle of fashion in Milan, they do get by. Unfortunately, we currently live in a world where all of our healthcare is provided by the equivalent of Via Montenapoleone.
Providing gradations of care is easier than you think and the system is already partially in place. Just as buying a premade suit and altering it slightly costs a fraction of the price of getting a custom-made suit, we could start by making mostly-premade healthcare. We could buy our prenatals with our tylenol and our flushots with our throat lozenges and administer them to ourselves. We could train technicians that specialize in just one or two surgeries and then are overseen by doctors. We could place healthcare centers staffed by nurses, physician's assistants or nurse practicioners in Wal-Mart and Kroger. We could consult doctors and nurses via webcam. If I can print my pictures in one hour, why can't a phlebotomist draw my blood as I walk into Costco and tell me my potassium and sodium levels as I leave? Heaven forbid I get an MRI taken by some technicians in a store in a strip mall and have the results read by a remote doctor (who could be anywhere in the world) at a fraction of the price of an in-hospital imaging lab. If you want the head of surgery to sew up your finger, you should be able to and you should have to pay for it. But, if you're okay with a nurse giving you a couple of stitches, you should be able to choose that and, thus, choose to pay less.
Do fewer accidents happen and better results occur if you follow extensive protocol with highly-trained staff? Probably. It's also safer to drive a Suburban than an Accord. The safety, though, just isn't worth the higher up-front costs, higher gas costs and aggravation at never fitting into a parking spot for most people. Give me shorter lines, lower prices and almost-as-good care any day of the week. I bet a lot of other people would choose it too.
