Before It Is Too Late

I read an article about "patients as consumers" this morning. It was long but reviewed how the law has treated health care patients.

Universal health care worries me. I worry about incentives for innovation. I worry about moral hazard. I worry about someone else determining what treatments my parents get or don't get. But I really don't think it is worth it to spend much time opposing it. Given my history, my genes, my feelings I am betting at worst it will be a wash for me.

But I still think the major problem is fixed costs. It takes so much investment to train doctors, nurses, and technicians. It takes so much investment in research for new drugs and new machines. Once the doctor is trained and the machine is paid for the marginal cost is relatively low.

I also think that doctors have a psychic (market) power over patients. Doctors do not do cost-benefit analysis with patients. Patients do not do a cost-benefit analysis and trust their doctor. Evidence based medicine can help this, but I do not trust statistics, especially when comes to a discrete event like life or death. I also believe in the placebo effect.

My answer has been some type of "flex" plan where patients make an up-front yearly contribution to fixed costs, and then pay the marginal costs during each visit. HMOs proved that this would probably not work. A single hospital would probably not be able to support all of every patient's needs, and the number of people needed to contribute to the program makes it private feasibility doubtful. People like choice and do not like long-term contracts.

So what I am saying is that I curious to see what our President-elect really does about health care. I say this while I am debating whether to go to the dentist to get my teeth cleaned or the doctor to get preventive blood tests done. It is all about trade-offs.