It's Economics 101!

Yet again. One very common conservative trope is that making people pay out of pocket for their health care will make them wise consumers and help control health care costs. This is not a finding, of course, it's an assumption, and it's an assumption based on a prior assumption that consumers have perfect information and behave "rationally" -- both of which are essential to the theory of the Free Market™.

Here is a very simple illustration of why this isn't true. When Blue Cross Blue Shield of North Carolina eliminated co-pays for generic medications, more people took their calcium channel blockers and other basic maintenance meds. These are very inexpensive medications that really do prevent strokes, heart attacks, and kidney failure, which are very expensive when they do happen.

A) People don't make a cost-benefit analysis that that tells them paying the 5 bucks for the pills is worth it, especially if they need the 5 bucks for something else; and
B) Even if they did know how to do the calculation, they might just say what the heck, I'll take the chance, it isn't really going to happen to me.

And for that matter, sometimes people don't have 5 bucks. But we still have to pay for their dialysis.

While we're on the subject, what's in that tea they're drinking anyway? The whole thing is supposed to be about cutting government spending, but the last thing in the world they will ever stand for is -- cutting government spending, specifically in this case spending on Medicare. The Patient Protection and Affordable Care Act created the Patient Centered Outcomes Research Institute, which will fund comparative effectiveness research, but the language specifically states that the institute "shall not develop or employ a dollars-per-quality- adjusted life year (or similar measure ...) as a threshold to establish what kind of health care is cost effective or recommended under Medicare." So we aren't allowed to save money because that would be "rationing." We have to cut spending, cut taxes, cut the deficit, and commit ourselves to infinite spending on Medicare. But we also can't guarantee health care for people under 65.

Makes perfect sense.

I am now headed for Windham County, which is positively infested with turkeys -- real ones, the kind the pilgrims ate, not the grotesque freaks farmers have bred with gigantic breasts and microscopic brains. Real turkeys can fly, quite well. And they're smart enough to thrive and multiply despite the harsh New England winters, and the foxes, coyotes and bob cats. If Ben Franklin had gotten his wish, and the turkey, rather than the eagle, had become our national symbol, would we be less inclined to go to war?