During today's health care summit, Senator Barrasso, trumpeting his bona fides as a physician and orthopedic surgeon, stated that cost is the first question a patient should ask when a doctor recommends a procedure or treatment. Perhaps because Barasso is a specialist, he may not be as acutely attuned to what constitutes the majority of doctor patient interactions. That is primary care. However, I am more convinced that Barasso is following political orthodoxy rather than prudent medical practice.
The conceit offered up by the Republicans is that the consumer is a better judge of how to spend health care dollars. Barasso ,and I think Coburn too, asserted that a closer nexus needed to be made between health care and health care cost. I suppose the idea is that people will be unlikely to use health care insurance and resources if they were aware of the real costs. But does it really work that way...
The answer is no. Most people are under the misapprehension that if they only use their health insurance when they really need it, the insurance company will pay. There are far too many stories of parents and patients stating "I paid for insurance for x number of years until..." The reality is that your individual usage of health insurance means little. Insurance is about large numbers and risk.
I may be going out on a limb here, but I doubt that insurance premiums are rising because too many people are going to the doctor. As has often been quoted, 80% of health care dollars are used by only 20% of covered persons. These people tend to be those with multiple chronic ailments and the elderly. In addition, let's face it, the U.S. offers some of the most advanced technology and science in the world and it is not cheap. Unfortunately, the U.S. spends twice as much on health care than the next highest country with no advantage in outcomes.
In my opinion, one of the reasons for rising premiums is the very contradiction of for profit health insurance. Health insurance is a rare business model where the presumed product (health care) is a cost to the bottom line. The bottom line for health insurance companies is the same as it is for any for profit company: maximizing shareholder value or return on investment. Think of it this way: if Toyota stops making cars (good or bad), they go out of business. If health insurance companies collect premiums but stop paying for health care, they make more money.
It is only in the interest of the insurance companies if consumers decrease their consumption of health care resources.
So in my opinion, as a primary care physician, Sen Barasso is wrong. The questions each patient should ask are these:
Will I get well? (truly that is the first question any human would ask)
If I won't get well, what can I anticipate my life will be like?
If a doctor suggest a procedure or a test: Will this test help to correctly diagnose or treat my condition? If not, why are you (doctor) ordering it?
Maybe because I'm a pediatrician, I can't imagine one of my parents asking me how much an asthma treatment costs or how much an x-ray will cost when their child is in distress.
People are not widgets or even cars. And while we can all improve our health with some prudent changes in lifestyle, much of what happens to us health wise is beyond our control.
Maybe that is the real ideological divide: the Republicans would have us believe that patients are informed enough to make health care decisions but not smart enough to understand the 2000 page health care bill.