Health care fix: “smoke the whole pack”

April 26, 2011 —

Finally, just a few days ago, I at last managed to complete the last class for my master’s of public health degree here at DMU. This explains why I haven’t posted in a while – it’s been tough working on two professional degrees at once. I figured that I ought to make it up to you guys, of course, so I decided to put my new degree to use in service of the populace. Specifically, I’ve decided to single-handedly fix the health care system. It was a tough feat, of course – the problem is that insurance companies exist so that patients can seek necessary health care when it’s really important, but too many patients make excessive use of these services and drive up the costs for everyone else.  Fortunately, after extensive deliberation, I’ve finally identified the root of the problem so as to open the door for a definitive solution.

See, under the current system, patients usually pay a co-pay or deductible (an amount people have to pay before their insurance company covers their medical expenses) that’s meant to be low enough that it doesn’t stop people from seeking necessary care, but high enough that a patient must think twice before going to the doctor without a good reason. If this disincentive didn’t exist, patients would visit their doctor for every last ache and pain and generate a financial burden for whomever picks up the bill. Of course, the question that often gets asked is whether insurance companies use these sorts of plans to promote judicious use of services, or just to pad their own pockets. Furthermore, when financial barriers prevent patients from seeking genuinely necessary care, easily treatable conditions are ignored until they become complicated and expensive. So the question that has been unanswered is this: How do we encourage patients not to overuse health care without creating perverse incentives or providing sub-par care? After much careful thought and reflection, I believe I’ve found the answer. I call it the “Smoke the Whole Pack” plan.

Okay, now bear with me for a minute here. Long ago, it was thought to be good practice that the best way to get someone to quit smoking was to make them smoke an entire pack of cigarettes at once until they were sick of them. No, I’m not proposing we do this in a clinical setting, but I think the basic concept can be generalized to other situations. The reasoning, essentially, was that the easiest way to make someone stop using something was to give them as much of it as possible until they hated it. So the other day, I thought to myself, “Hey, what if we adapted this logic to fix excessive health care utilization?”

So here’s the genius idea: In my new “StWP” plan, doctors will respond to office visits for simple and uncomplicated illnesses by providing every possible service remotely associated with the complaint. For example, a patient who visits the doctor for an uncomplicated headache need not be charged a co-pay. They will, however, have a head CT, a spinal tap and every single blood chemistry drawn. Conversely, if they have a cold, they won’t actually need to pay a dime for their visit. Instead, they’ll simply have to undergo a full-body MRI, a lung biopsy and an ELISA test run for all viruses known to man (exotic viruses will not be excluded, of course). For men over 50, every office visit will also include a colonoscopy.

The message we sent with the old system was “You want health care? That’s fine, but this stuff ain’t free.” The message we’ll send with the StWP plan is “You want health care? Oh, we’ll give you health care…but careful what you wish for.” Insurance companies thought that a little $20 check was enough to scare people away from booking too many appointments with their physician. But what they didn’t realize is that the only thing that really scares people away from the doctor is the prospect of a colonoscopy. Best of all, unlike traditional disincentives, the StWP leaves no opportunity for small and uncomplicated illness to go unaddressed. After all, if a patient comes in for so much as a splinter in their big toe, the doctor will have tested for everything from a case of the sniffles to the black plague before treating them. Sure, they won’t go to the doctor as often, but when they do…they really mean business.

So that’s my grand idea – the product of a sleep-deprived medical student with too much time on his hands who had one too many feverish dreams following his last health administration exam. But hey, every truly genius idea comes in the disguise of madness. And I think we can all agree – this one has a pretty convincing disguise.


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