Beneficiaries Are Better Shoppers

High deductible insurance not only puts the beneficiary back into the position of being a shopper of what he/she consumes, but it also makes the person a better shopper when entering the medical system to purchase services. If your doctor says that you need a $1000 MRI scan and the thousand is going to come out of your pocket, you are much more likely to ask the hard questions that patients almost never ask today: What good is it going to do me?

"Well," says the doctor, "It is possible that you have epiglootis oogagus acutus, and only an MRI scan will show that."

Says the medical shopper, or his designate if he is too ill to think clearly, "Well, just how likely is this to be epiglootis oogagus acutus?"

Now, the doctor is not accustomed to answering questions like that, and may hem and haw a little, but after looking it up finds that the chances of it being that are about one in 40,000.

The astute shopper realizes that this risk is close to the normal risks of ordinary life, such as driving to the next town on a Wednesday morning. The shopper asks further, "If it did turn out to be epiglootis oogagus acutus, what can be done for it?"

"Well, of course, we would treat you," says the doctor, as if he were talking to someone whose elevator doesn't go all the way to the top.

Pressing undeterred, the patient asks, "How successful is the treatment?"

Sure now that he is in conversation with someone with only one oar in the water, the doctor answers, "Thirty-five percent of treated people recover completely," with an air of finality, hoping to shut down this inquisitor so he can get on to the next patient.

Uncaring of his developing reputation as a lamebrain, the patient has one final question: "How many untreated people recover completely?"

The doctor has to look it up. Sheepishly, considerably later, he mumbles, "Thirty-two percent." I hate to run numbers, but roughly, for a mere $1000 MRI, a patient can have a chance of 1 in 40,000 disease diagnosed, but stands only perhaps a 3% better chance at recovery than if he never had it diagnosed at all. That would come to $40 million per case diagnosed, and to about $1.3 billion for each extra cure effected. Actual calculations are more complex than that, but this estimate rather substantially underestimates the expense.

This kind of reasoning is commonplace in medicine. Ordinary medical practices for which the actual payoff to the patient is unknown, marginal, or even negative include: the "complete physical examination," screening for prostate cancer, screening for diabetes, screening for spinal scoliosis, cholesterol screening and treatment, and, I am recently astonished to discover, even for the time-honored Pap smear in most cases. Any medical system which pretends to protect us from risks as low as one in 40,000, or even from more likely risks but at huge expenses running into the hundreds of thousands or millions of dollars, is a system of idolatry.

Where is the money going to come from? From our own better-informed pockets.


Excerpt from talk given at Westminster Presbyterian Church