Consumer Sovereignty

As I believe I may have mentioned a few days back, I had a little thing on my tongue. This morning I had it biopsied -- or really, removed. First the surgeon punched out a sample, then she took a scalpel and dug out the whole thing. Yes, it's as unpleasant as you imagine.

Sure, we let doctors do incredibly painful and repulsive things to us, on the faith that it's worthwhile. And I use the word faith advisedly. I accept that evolution and anthropogenic global warming are for real because I have studied the evidence well enough to be convinced. Even if I hadn't, there is such a powerful consensus of experts in both cases that I would be willing to take that as evidence.

However, if you ask me whether I really needed to have that thing biopsied I would have no good answer. It didn't seem like anything dangerous -- just a little smooth spot, basically. It wasn't growing, wasn't painful. The specialist even told me that it didn't look overtly suspicious, but she wanted to take it out anyway.

There's no consensus of experts who have deeply studied my case here -- just one individual who gets paid a handsome fee to do what she advised me to have her do. She doesn't have to suffer the pain. On the other hand, I have very good insurance and this only cost me a $10 co-pay.

So here's where I'm really going. Republicans say we can control health care costs, and make everybody free at the same time, by giving regular folks crappy insurance, or none at all if they can't qualify or afford it, and making us pay more out of pocket. If I'd had to pay for the procedure and the pathological examination, there's no doubt, I would have been less inclined to go through with it. But . . .

Suppose the doctor knew that the chance of the thing being, or potentially becoming malignant was non-trivial -- which I presume was indeed her sincere belief -- and suppose I happened to be on the wrong side of that bet? Would my decision have ended up saving money? Yes, I suppose it might have if I died quickly enough and never made it to Medicare. Otherwise no.

So raising co-pays and deductibles is not the way to create a more efficient health care system, and giving everybody good, comprehensive insurance is not the cause of waste. Just look around the world and you will see that is obviously true. What we are buying from physicians is expertise. Making me decide what to do based on my out of pocket cost defeats the entire purpose of the enterprise. This is just trivially obvious.