Friday, November 02, 2012

The Fetish of Choice 

The idea that free choice of health care provider is some kind of inalienable right, regardless of who pays the bills, looms as one of the most important barriers to getting the cost of health care under control. 

Although the system of delivering health care has changed a great deal in recent times, medical practice remains at the center of it.  Thus, changing the way medicine is practiced has to be an essential element of any realistic attempt to restrain or reduce the cost of health care.  Physicians are not likely to do that on their own.  They practice the way they do because, all things considered, it is the way they believe works best for them and their patients. 

But they would look at it differently if practicing the way they do came to have adverse economic consequences for them,.  If insurance companies were able to refuse to pay physicians they determine to be wasteful, incompetent, or both, such physicians would have a powerful incentive to improve.

But the principle of free choice prevents that from happening.  So long as insurance companies have to pay whatever doctor the beneficiary chooses, a powerful tool for change will be foregone. 

Actually, free choice is not as important as it is made out to be.  When doctors die, retire or move away, their patients have to find new ones.  People move from one town to another and have to change physicians.  When patients go to the emergency room, they are cared for by whichever physician happens to be on duty at the time.  If they get admitted to the hospital as medical patients, they may well be treated by a hospitalist physician they do not select.  There are few complaints about any of these things. 

But if their insurance company asks them to change doctors it is considered a violation of a right that politicians of every stripe promise to protect. 

It’s another example of how cost control in health care requires culture change.


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