Sunday, April 10, 2016

Where Is The Personal Responsibility In Healthcare?

How is medicine different from other businesses? And let's face reality--medicine is a business. It's an enterprise that costs $3 TRILLION per year in the U.S., consuming 17.5% of our GDP. Yet it is also a field where its customers are under no obligation to pay for any of its services if they can't or don't want to.

Take for instance this article in the LA Times about people who live on minimum wage. There are plenty of profiles of people whose housing and transportation costs make up a large majority of their monthly income. Therefore they have to prioritize their needs with what's leftover from their paychecks, and healthcare seems to fall to the bottom of the list.

Carolyn Allen works as a custodian at Atlanta's Hartsfeld-Jackson International Airport. She makes close to minimum wage of $7.70 per hour. Yes life on income that low is tough. "I budget and budget, and I still really can't buy no food," she bemoans. Her rent takes up half of her $1,000 monthly income. Transportation takes another 10%. She has a $100 bill from the hospital for an emergency room visit that she hasn't paid in months. Yet this person, who just claimed she doesn't have enough money for food, pays $86 per month for her cellphone.

Wait. What? She has money to throw away for expensive cellphone plans but denies being able to pay for services staffed by professionals 24 hours per day willing to treat anybody no questions asked? Granted a cellphone these days is practically indispensable as a tool for work and social interactions. But if she really needs to save money there are plenty of cheap plans that cost far less than what she's paying now. Bottom line is she prioritizes her cellphone over her hospital bill because she already got the medical services she wanted but her cellphone company would cut her off after 30 days of nonpayment. How's that for running a business into the ground?

This just crystallizes doctors' cynicism toward sob stories about people who want free this and free that because, oh my god, they might have to pay for it themselves. Doctor's visits? If they have to pay the $20 copay then they might not make their annual visit and develop terrible chronic diseases costing the system more money. Birth control? Must be given gratis because heavens forbid they might get pregnant because they couldn't spend $1 out of pocket for a condom. Subsidized health insurance? People better pay more taxes because otherwise they would just run to the emergency room costing society more money. Sounds like we're spending trillions of dollars on healthcare each year due more to coercion than charity.

Society has become obligated for the individual because now there is no accountability for a person's irresponsibility. Enforcing personal responsibility is viewed as cruel and uncaring. Therefore the only answer that is proffered is to throw more money at the problem so everybody gets more free stuff. No sane or solvent business can be run like this for long. But then again medicine has become an enterprise that is too big to fail. The government will just have to keep taxing and spending until ultimately people eventually run out of money.

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