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: 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.”