Tag Archives: insurance

But What About…? Part 4b: Healthcare Introduction, Part 2

In Healthcare Introduction, Part 1 yesterday, I started talking about the doctor/patient relationship, and how third-party decision makers (government, insurance companies) shift the medics’ accountability from you to them, shifts the decision-making ability from you to them, and I touched on how this drives the price up. I ended the post introducing another third party, how things become more complicated when an employer gets in on the mix.

When an employee gets paid, that money is the employee’s, and the employer has no reasonable right to any say in how the employee spends the money. Prior to that, there’s things the employer must pay for. Various insurances, Social Security. Various storms flew up with some employers that provided health insurance, when they were suddenly forced to pay for some coverage they found to be morally dubious.

And there’s the distinction. Some have argued that it’s the employees’ health insurance, and the employer should butt out of it. But as the employer is actually paying, they are morally complicit. This didn’t seem to be a big issue until the government stepped in with a gun to the employers’ head, saying “You don’t get a conscience! You must do these things!” On the other hand, if there are options you would choose but your employer won’t, that would obviously be frustrating.

Interestingly, there’s a conversity we haven’t seen much of: if an employer provides insurance that the employee considers morally dubious. I think there’s reasons for this getting less coverage, I also suspect there’s many who suck it up and live with it so as to not bite the hand that feeds them. “It’s better than nothing, there’s good in it that I don’t want them to take away.” Still, the same enforced moral complicity that I mentioned above exists here.

Another problem with third parties choosing what treatments you can and cannot have, is the value judgments. Does someone even deserve treatment. It’s understandable (but heartless) not to want to treat a smoker for lung cancer, but it sucks if you’re the smoker and you’ve paid your NHS taxes/US insurance. Or refusal to do a proper examination on a fat person until they’ve lost weight (a scientifically dubious demand in itself).
Patient: My knee’s shot, I think I might need a joint replacement
Doctor: Lose weight first
P: How?
D: Exercise!
P: On a joint that needs to be replaced?

There are kinds of treatments that the NHS won’t cover, rightly or wrongly. Even rightly, it robs patients of say and choice. To be free, one must be free to make mistakes. Grown-ups capable of making their own decisions should be treated like grown-ups capable of making their own decisions.

In conclusion, the greatest moral freedom, the greatest choices, the lowest cost, and the best care, come when you cut out all the middle men.

Although, a word of caution from the great philosopher Malcolm Reynolds: “About 50% of the human race is middle men, and they don’t take kindly to being eliminated.”

But What About…? Part 4a: Healthcare Introduction, Part 1

Having lived in England for most of my life, and America for a significant number of years, I have had some experience of the different medical systems, some good and some bad. Thus, this subject of healthcare is somewhat personal to me, and it’s easy to get wrapped up in it. I might be a bit more opinionated than usual. There’s a chance your reactions will be more charged than usual (I have seen many heated posts on my Facebook feed when someone dares threaten the sacred cow that is the NHS). Please grant me some extra patience, then, as we discuss this topic.

The US and UK healthcare systems are, in some ways, vastly different. In other ways, they are very similar. Some of the ways they are similar aren’t very good at all. I’ll talk about these some over a few posts.

A pitfall of both the NHS system in the UK, and the insurance system in the US, is it disrupts the business/customer aspect of the doctor/patient relationship. Broadly speaking, the business answers to the one who pays the bills, and if you’re not paying the bills directly, then your say is greatly reduced.

Take birth, for instance. You might not like the hospital version of birth (put you on a clock, monitor so you can’t move like you need to, drugs to speed you up, drugs to stop the pain, highly unscientific breaking of waters, you’re taking too long so cut the baby out). My experience of hospitals in both countries, were that they tended to be like this.

The World Health Organisation put out literature saying that a caesarean rate of more than 10-15% was not medically necessary. I think the 15% was a concession, I seem to recall another document being more hardline with 10%. I checked up on the UK hospitals we used, they were higher than that.

In the NHS, and in the US insurance system, there are people who decide what kinds of treatments they will pay for. Insurance in the US might very well not cover safer, cheaper, maternity alternatives. VBAC is even worse. The NHS at least on paper supports homebirth, though the vibes we got from some of the midwives we were dealing with led us to not trust them.

In neither country are the hospitals and medical staff accountable to you for an unnecaesarean.

I find the “cascade of interventions”-style treatment unethical. Profitable for surgeons and drug companies, yes, ethical, no. I have no desire to fund or support it. If you like it and want to use it, that’s your choice to make. I don’t want to force what I think is best onto you.

But statism doesn’t return the favour. In the UK, I must fund the system I don’t like, and if I want something better, I pay for that on top.

In the US, the governmental interference (“Affordable Care Act”) has caused all sorts of problems. People required to have some coverages they don’t need or want.

That’s not to say there aren’t people who have been helped. There are those, for example, with pre-existing conditions that can get coverage, who couldn’t get it before. The underlying issue of just why a doctor’s visit and a few tests costed (and still costs) an arm and a leg, has been entirely undealt with. Insurance companies decide what they will or will not pay for, and hospitals charge the insurance companies more because they can afford it.

The waters are further muddied when employers are brought into the mix.

I know I’m kind of cutting off in mid-stream here, but come back tomorrow for more!