I don’t think that the positional aspect is as big of a deal as some of you do. I really don’t know or care what my neighbor’s health care plan covers. And if he claims it covers daily massages or something, I’m just going to think he’s lying.
But there are a still a lot of economic irrationalities going on. Take my former “Cadillac” plan. (I don’t really like that term, it colors the debate by implying a massive difference in QUALITY of care that doesn’t really exist. I prefer “car that always works and takes you wherever you want to go plan”)
I picked it up for the one year because I knew I had two upcoming surgeries. But this plan made absolutely no rational sense for anyone, because the premimum was over $150 a month more than the plan with the $2000 deductible. So really, all I was doing was paying the deductible over the course of a year, whether I used it or not. This plan made absolutely no rational sense.
But when I was deciding whether to get therapy, it made a difference. When I was deciding whether to see a doctor now or wait a week, it made a difference.
When that “first dollar” ordinary care was, in effect, prepaid - I was determined to use it whether I really needed it or not. I was making a cost benefit decision but the cost was not based on the value of the service I was receiving. It was an artificially low copay that could be described as practically nothing. So I didn’t have to perceive much benefit in order to decide to consume the service.
But when I knew the visit meant I’d be writing a $200 check at some point, I made the cost -benefit decisions of a rational consumer, and often decided to use the money for something that would give me a greater benefit.
But the medical establishment has conditioned us to believe that it is wrong to make rational cost benefit decisions with regards to our health. We are taught that it is wrong to even consider cost when it comes to the matter of our health and that we are risking our lives, livelihood and futures if we don’t have immediate access the most advanced and effective treatment for even minor ailments, cost be damned.
So don’t try to treat that rash with an OTC cream for a week or so first, head to the dermatologist for a $350 consult and a tube of $200 prescription cream NOW! Doing anything else is like playing Russian Roulette with your HEALTH! Money should not be a factor (and, of course ,someone else should pay the bill.)
I had an actual turning point with regards to this attitude. I have told this story before on this forum. Several years ago, my right ear canal was chronically itchy. My doctor ruled out disease and infection and gave me a prescription for an ear drop. This was not a dangerous issue. It was not at risk of spreading or becoming more serious. It was not a symptom of something larger. It was strictly a comfort issue.
I filled that prescription dutifully for months, paying my $15 copay every time. Then there was some sort of insurance glitch and in the process of straightening it out, I discovered my insurer was paying around $200 for each .5 oz bottle of ear drops. I looked at the eardrop bottle. The active ingredients were hydrocortisone and acetic acid (white vinegar).
I refused to fill the prescription anymore. I told my doctor I was going to buy a dropper bottle, a bottle of white vinegar and a tube of hydrocortisone cream and mix up about 10 grand worth of ear drops in my kitchen. She was fine with it.
So I became a rebel of sorts. Every time I filled a prescription I insisted on knowing the real cost, not just my copay. And sometimes I wouldn’t fill it. And since then I have tried, as much as possible within our fucked-up health care system, to make rational cost benefit decisions with regards to my own health.
It’s an exercise in futility but I do it anyway.
