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.