Jewish World Review June 5, 2003 / 5 Sivan, 5763

Drs. Michael A. Glueck & Robert J. Cihak

The Medicine Men
JWR's Pundits
World Editorial
Cartoon Showcase

Mallard Fillmore

Michael Barone
Mona Charen
Linda Chavez
Ann Coulter
Greg Crosby
Larry Elder
Don Feder
Suzanne Fields
James Glassman
Paul Greenberg
Bob Greene
Betsy Hart
Nat Hentoff
David Horowitz
Marianne Jennings
Michael Kelly
Mort Kondracke
Ch. Krauthammer
Lawrence Kudlow
Dr. Laura
John Leo
Michelle Malkin
Jackie Mason
Chris Matthews
Michael Medved
Kathleen Parker
Wes Pruden
Sam Schulman
Amity Shlaes
Roger Simon
Tony Snow
Thomas Sowell
Cal Thomas
Jonathan S. Tobin
Ben Wattenberg
George Will
Bruce Williams
Walter Williams
Mort Zuckerman

Consumer Reports

Soaring Medical Costs: Rational ignorance or rational enlightenment? | Someone (an economist, no doubt) once remarked that the plural of "anecdote" is "data." Now, two anecdotes doth not a data make - although they do make more than a datum. However, when it comes to what economists sometimes call "rational ignorance," the two anecdotes presented here may well resemble a whole lot more.

In economics, rational ignorance refers to deliberate and logical decisions not to become informed about something. For example, you can be rationally ignorant of very important political and cultural affairs. Sure, it matters what the government or the church is doing, but if you can't influence the process or the outcome, you're usually better off spending your time on things you can impact. But rational ignorance can also refer to deliberate unwillingness to understand something, lest it affect what you perceive to be your "interests." Or, as Radar says on M*A*S*H, "Some stuff you're better off not knowing."

Or are you?

Anecdote First:

Dr. Del Meyer is a Sacramento, CA, lung specialist who e-publishes a weekly review of medical policy issues ( One of his patients is a retired military man. Dr. Meyer sees him as a private patient, covered by private insurance. But this patient is also treated at military and Veterans Administration hospitals, for the same conditions. When Dr. Meyer pointed out that having three non-consulting doctors might be hazardous to his health, the patient shrugged it off. Health care in triplicate had value to him.

But, writes Dr. Meyer, "When I tried to point out that he was duplicating if not triplicating his health care costs, he begged to differ. He said that the private insurance was a benefit of his previous employment and, therefore, didn't cost anything. He also felt that he had earned the right to obtain the services of the military and VA government hospitals and did not see it as an unnecessary cost."


We do not dispute that this patient was entitled to the care he received. But we do hold that he was "rationally ignorant" of the fact that out-of-pocket costs are not the only costs involved here. In the end, this person would bear a share of it . . . perhaps when total costs of medical care grow so great that the government and the private insurers have to start saying no.

Or have they already? Anecdote second:

JWR's Anne Applebaum writes about what happened when her five year old son tumbled off a staircase banister, followed by screams of "I can't walk." Ms. Applebaum, like any good mother, took him to the hospital, where "the emergency room staff went into high gear: X-rays, Cat scan, intravenous drip, blood tests, urine tests, EKG."

These good folks plunged into a rational ignorance all their own, perhaps a more complex and justifiable form than in the first anecdote. Writes Ms. Applebaum, "They must have calculated, although they denied it when I asked, that mothers of five-year-olds with undetected injuries are prone to lawsuits. They must have realized I had insurance. So - just to be certain - they carried out every conceivable test, even some that might have been unnecessary, or very expensive, or both."

Yes, the fact that she had insurance made it easier for her to let the tab run; it also allowed the doctors to practice "defensive medicine." But again, their belief that it cost them nothing was, in the long run, as wrong as the retired military patient's sense that, because he was entitled to his benefits, he should use them to the max.

So what's the antidote for rational ignorance? Certainly not a crash course in the economics of health care . . . which can be very bad for your mental health. Rather, the antidote lies in understanding what economists mean by the "fallacy of composition." This holds, in essence, that things are more than, and often very different from, their parts. For example, if a woman saves fifty percent of her income, she generally grows more financially secure. If everybody in the nation suddenly starts saving at anything near that rate, the result is a depression catastrophic for all.

Or, to put it another way, there is no such thing as free medical care. Which is why most of us are paying far too much.

For those who wish to become a bit less rationally ignorant on this matter, we suggest a simple exercise. Find out how much your employer pays for your health coverage. Then ask yourself, how much do I want to spend - or how much can I afford to spend - on health insurance, on groceries, on my kids, their education, etc.?

If you want to translate those thousands of medical coverage dollars into your own reality, work with your employer to get medical coverage that meets your family's budget priorities - and most likely have several thousands more dollars to take home for your family.

The choice is yours to choose and practice rational medical ignorance - or enlightenment.

Michael Arnold Glueck, M.D., is a multiple award winning writer who comments on medical- legal issues. Robert J. Cihak, M.D., is past president of the Association of American Physicians and Surgeons. Both JWR contributors are Harvard trained diagnostic radiologists. Comment by clicking here.


05/30/03: A Tale of Two Admirable Women: Jessica and Annika
05/23/03: Latest medical innovation: Cash
05/09/03: We feel your pain; Physicians have it too no thanks to the DEA
05/02/03: Medical Quarterbacking
04/25/03: CNN the "Conscience-Not Network"
04/21/03: Medical Miranda?
04/11/03: Are childhood vaccines shots in the dark?
04/09/03: The PETA Principle -- The lambshank Redemption
03/28/03: American conscience?
03/21/03: West Wimps or Wings: Treatment for Hollywood Hypocrisy
03/13/03: Worldwide schmaltz shortage looms --- all because of a featherless chicken
03/06/03: Legal metastases are killing us
02/28/03: Outside the Jury Box: Seeking Justice rather than a Lottery in Medical Liability
02/21/03: Workforce temperature rising; employer TLC in demand
02/14/03: Malpractice Insurance: They Reap What They Sue
02/12/03: Hawk, Dove or Groundhog: Diagnosis Critical List; Prognosis Uncertain
02/07/03: How about tax cuts for the "rich" and "poor"?
01/31/03: AIDS Bug Chasers
01/24/03: Libertarian moment or movement?
01/17/03: It's not just 'sue the docs' anymore
01/03/03: A pox on the critics; diagnosis sour grapes
01/03/03: If protesting is good for your health; then at least let's root for the home team
12/20/02: Obesidemic (obesity epidemic) or not?
12/20/02: Time for voluntary informed smallpox vaccinations
12/13/02: The real reason the state opposes homeschooling?
12/06/02: Conscience of a former conservative: Portrait of a political metamorphosis
11/27/02: Thanksgiving dinner hazard?
11/22/02: Time to think outside the box and inside the nucleus
11/15/02: The military should be protected from abusive environmental laws in times of war
11/11/02: Does Kyoto Treaty pose more harm than global warming?
10/31/02: Deep thoughts on Baseball, the World Series and Life: How about them Anaheim Angels?
10/23/02: "Pediatric rule" guinea pigs
10/23/02: Once the World Series ends, we need to create a Donnie Moore Day of Remembrance: Sports and mental health
10/18/02: Congress to senior patients: Do as we say not as we do for ourselves
10/11/02: Using pollution "scare labeling" to political advantage
10/04/02: The Great Asbestos Heist: Did Litigation and Junk Medical Science Helped Bring Down the World Trade Center?
09/27/02: The imminent rise of civic feminism: A far healthier national alternative in war and peace
09/20/02: A Ray A Day" to replace the daily apple?
09/13/02: Beware of celebrities hawking drugs
09/06/02: Avoid 9/11 overdose: Give blood to begin "September of Service," SOS
08/28/02: From Doubleday to strikeday: Baseball's collective anxiety attack
08/23/02: Should she or shouldn't she?: An alternative view on treating menopause with HRT
08/16/02: Cooking up defenses against germ warfare
08/02/02: Medicine, crime and canines
07/26/02: Lies, pathologic lies and the Palestinians
07/19/02: Medicare Drug Follies as in "now you see it, now you don't"
07/12/02: Anti-Profiling: A New Medically False Belief System
07/08/02: Don't procrastinate, vaccinate!
06/28/02: The scientific advances on the safe and effective deployment of DDT are being ignored, or denied. Why?
06/21/02: Sex and the system: In seeking healthcare men are different from women
06/14/02: The FDA, drug companies and life-saving drugs: Who's the fox and who's the hen now?
06/07/02: Medical Privacy Lost: A hippo on the healthcare back!
05/24/02: To clean up America's game: A (soggy) ground rule
05/10/02: Free speech is good medicine
05/03/02: Medicine's Vietnam
04/26/02: Attack on alternative medicine could lead to alternative lawsuits
04/12/02: Insure the 'crazies'?
04/09/02: No Time for Litmus Tests: In War We Need a Surgeon General and NIH, CDC, and FDA Directors
04/02/02: The scoop on soot: A dirty rotten shame?
03/22/02: Too many beautiful minds to waste: The first annual Caduceus Movie
03/15/02: Terror and transformation: Defense essential for health & state of mind
03/08/02: Diagnosis: Delusional
03/06/02: The great matzah famine
03/01/02: Is new Hippocratic Oath hypocritical?
02/15/02: Why the recent moaning about cloning?
02/08/02: Searching for Dr. Strangelove
01/15/02: Score one for the value of human life
01/04/02: Medical-legal-financial wake-up call
12/28/01: Who's afraid of a 'dirty bomb'?
12/21/01: End of medicine?
12/14/01: More heroes: Docs deserve a little credit after 9/11
11/16/01: Do we need 'Super Smallpox Saturdays'?
11/09/01: Why the post-9-11 health care debate will never be the same
11/01/01: Common sense good for our mental health
10/26/01: Your right to medical privacy --- even in terror time
10/12/01: Failed immigration policy ultimately bad for nation's mental health: Enemy within leads to epidemic of jumpy nerves
09/28/01: Can legal leopards change their spots: A treat instead of a trick
09/21/01: Civil defense again a civic duty
08/30/01: Shut down this government CAFE
08/23/01: School Bells or Jail Cells?
08/15/01: Time to take coaches to the woodshed
08/10/01: Blood, Guts & Glory: The Stem of the Stem Cell controversy

© 2002