Michael 2006-11-06
From Summa Bergania
Michael (my brother who is currently in medical school) is responding to my essay on Modern Health Care.
From: Michael Bergan
To: David Bergan
Date: Nov 6, 2006 12:39 PM
Subject: RE: Tell me what you think...
Essay looks good.
I'd talk about it with you sometime, rather than write a 3-page response.
Things that could be added for completeness (arguments missed or neglected)
Health Insurance Pros:
People go to the doctor now--ounce of prevention worth a pound of cure. A majority of serious conditions can be spotted easily when they are at the moderate to semi-serious state, and be dealt with way more effectively than in the ER at life-threatening state. These can be found by getting a detailed patient's health history and physical examination. (your $30 check-up)
Doctors can't charge whatever they want for procedures--i.e. overcharge. While in free market, over-charging loses business, due to the emergency nature of many health crises, people might not have the opportunity to shop around for best prices. Often, price wasn't talked about until afterwards when you got the bill. Or there is only one doctor in the area that can do ____ and can charge whatever. Similar to how auto insurance has stopped certain body shops from charging whatever, health insurance has regulated pricing here too.
Health Insurance Cons:
While the majority of diseases can be caught with history and physical exam, to officially diagnose them, (i.e. to know for sure) there is often some lab tests. This is where doctors/hospitals make there money, as they should, if you are legitimately sick. The problem is trying to catch the diseases before they are even a problem, i.e. assymptomatic. This is the ideal time to catch a disease, but it is also the most expensive to find it. Hence, lots of screening tests are done to check for colon cancer, prostate cancer, breast cancer, cervical cancer (pap smear) which are highly SENSITIVE (pick up something) but not specific. These cost some money, but not a ton. The problem is when it comes back positive, it has a REALLY high false positive rate. So a more SPECIFIC (and more expensive) test has to be done (and more dangerous). I.E. colonoscopy comes back positive, now as a doctor, you are obligated to do a more expensive/invasive colon biopsy to see if it is cancerous. And let me tell you, most people will want it done because everyone knows cancer is bad, and they don't want it, and if you can catch it early and prevent it, do it. Don't care if it costs $500- $1000. (especially when insurance pays for it, but even if it doesn't). Each cancer has its own statistics, but from what I remember, the cervical and breast cancers are worth checking for (good cost-benefit ratio), whereas the colon and prostate and many others really aren't.
I said I wasn't going to write a paper, and obviously I can't stick to bullet points.
People who can't afford or qualify for insurance get the biggest shaft. A barber cut my hair in Vermillion and told me about how the hospital charged off the chart prices that she can't pay for her procedure. Obviously I got her biased position, but it basically sounded like usury. Since insurance companies don't always reimburse enough for certain procedures, they often have to charge those who aren't insured the difference--maybe 3 or 4 times as much. Obviously, these are the people who probably couldn't afford it either. This is why the AMA (well, one of the reasons, or the altruistic reason) wants all people to have insurance--stop price discrimination against poor.
Also, Massachusetts just passed a law that everyone will have to have health insurance (like car insurance to drive, need health insurance to live) Not sure when it goes into effect, but I'm sure it will provide insight to your essay.
Michael
