Perverse incentives

One of the advantages of living in more civilized countries rather than the United States is general access to health care. If you travel abroad, you might notice clinics everywhere. People can stop in at any time – not to see a specialist or a surgeon, maybe not even a doctor, but a knowledgeable person. Most of our day-to-day concerns are indeed trivial, and most things take care of themselves. But many times treatment of small issues head off large ones. This is a large part of the reason why health care systems in other countries produce better outcomes than ours – easy access to preventive care.

I have noticed with the insurers that I have dealt with that they are backing away from paying for visits to doctors’ offices. Such visits are highly bureaucratic affairs in our land, needing clearance from an insurer to proceed, and each doctor required to deal with every insurer separately. However, I used to be able to see a doctor and only be charged a modest co-pay. The last policy I carried*, which had increased significantly in premium, dropped this feature. Not only were doctor visits no longer covered, but their costs could not be applied towards the policy deductible. Also, there was before an illusory “discount” applied when we visited a doctor who was part of a larger network – that too disappeared. My health insurance policy premium increased dramatically, and they quietly converted it to hospitalization only.

That’s pretty damned short-sighted from a public health perspective, but what can we expect when we entrust public health to private corporations? No doubt as they sat around discussing more ways to gouge us for profit, they saw elimination of the co-pay as a road to riches.

Private for-profit corporations cannot, by their very design, deliver a public good like health care. They can only limit it.
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*Anthem Blue Cross of Colorado. Others I have looked at are doing this now too – this is the nature of competition in monopoly capitalism – when one stops offering a service, so do the others.