Jewish World Review June 5, 2003 / 5 Sivan, 5763
Drs. Michael A. Glueck & Robert J. Cihak
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?
Dr. Del Meyer is a Sacramento, CA, lung specialist who e-publishes a weekly
review of medical policy issues (www.medicaltuesday.net). 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?
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
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.
JWR contributors are Harvard trained diagnostic radiologists.
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