Junior Ganymede
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Reduce Health Care Costs By Having Us Pay Routine Care Out of Pocket

February 17th, 2010 by Bertie

My friends will tell you that I’m rather a pacific chap, harmless as a dove and all that, if not more so, but there are times when one simply has to rise in the righteous wrath of the Woosters.

It’s all very well these healthcare mavens proposing to fix the system by the simple expedient of making John Q. Public brass up for his own basic healthcare with his own doubloons. Or his own krugerrands or thalers or wampum, as he prefers. But what of the fellow who is beset with aunts? Yes, what price aunts? Many’s the hale young fellow hounded into an early grave by a baying pack of aunts–not that they would, bay I mean, I speak figuratively–with nary an epidemiologist in sight to buck him up. Rather gives one to brooding.

This is a problem the mavens should put their beans to. Administrations too, or I dare say their polling among likely Drones Club voters will down in the wine cellar. Ignore the Aunt Question and we shall kick like steers, dash it.

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February 17th, 2010 08:43:43
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February 17, 2010

Or his own krugerrands or thalers or wampum, as he prefers.

Might I suggest quatloos. I have always found that episode amusing, though perhaps not in a way its writers and producers intended.

Without overlooking the grave objections raised by Mr. Wooster, I venture to recognize the not inconsiderable merit to the idea of paying routine medical expenses out of one’s own pocket. Of course, under the current U.S. system, including these in health “insurance” gives the insured a substantial tax break on such expenses. One could of course preserve this feature of the system through tax exempt medical savings accounts.

One objection to this policy that could be anticipated is that people left to their own devices will neglect to pay for routine preventive care. I fear this objection is not decisive. I am not aware of a single study backing up this proposition. The popularity of health food, exercise plans, and the like suggests that the health-conscious are little deterred by expense; while those who choose to neglect their health will continue to neglect it even when its cost is subsidized. The Americans have had considerable experience with HMOs over the last few decades, and it appears that the chief original selling point of HMOs — long-term reduction in costs through short-term subsidization of preventive care — has not eventuated.

I placed “insurance” in quotes because its use to describe the present American system is semantically in poor taste. Real insurance protects against low-probability, high-consequence mischance. The Americans call this [i]catastrophic[/i] medical insurance, but that usage is redundant.

One must also mention adverse selection, which is the tendency of those with preexisting conditions to be more likely to purchase insurance. Requiring patients to pay routine costs out of pocket helps reduce adverse selection, but of course the person who (exemplia gratia) contracts diabetes is left with an expensive condition through no fault of his own that will follow him through his now somewhat shorter life. We cannot but feel sympathy for these individuals. Were I to gain the ear of the officials responsible for health care policies, I would encourage the creation of annuities, similar to life insurance, that place a substantial lump sum in the insuree’s medical savings account upon a diagnosis of diabetes or other similar chronic conditions, to help defray future expenses. The incentive structure to wisely husband one’s use of medical care would remain.

But, of course, I do not have the ear of the relevant officials. Unlike our own elite, the American upper classes are not keen on gentlemen’s gentlemen, preferring to hire persons of, shall we say, uncertain visa status in purely menial roles. As a result, even as otherwise admirable a gentleman as Romney has erred on some aspects of health policy. Though I must add that, if there was ever a gentleman who possessed sufficient intellectual power of his own, it would be Romney.

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