Thursday, July 26, 2012

Free Riders


I recently finished 2 weeks as ward attending in the hospital. As a full time hospital employee, I have responsibility for Medicaid patients and the uninsured. Patients with health insurance, including Medicare, are cared for by the private practice physicians. I am quite comfortable with this arrangement, as I get to pat myself on the back for providing the same quality of care for the poor and unlucky that everyone else gets.

But nothing in life is free. We both know, ultimately who pays for the extraordinary amount of resources that these patients consume. You and I do, only the cost is hidden from us.

You are absolutely right that Obamacare is a route to rationing, be it through price controls or some other top down mechanism. But we have rationing now. It reminds me of the old Soviet Union phenomenon of people waiting on line to buy shoes. The Democrats want to drive down the price of health care by becoming the only game in town and then saying "take it or leave it" to providers. The Republicans want to let us all shift for ourselves, which means that people like you and me will get what we want (I hope!), and for those less fortunate, well, too bad.

The one thing I no longer worry about is that we will continue to get bright people to go into medicine, even if they can longer get rich doing it. The international experience is informative here. Doctors across the industrialized world remain among the elite. It's still a deeply honorable life.

Meanwhile the Massachusetts House and Senate are are reconciling their version of the current health care spending bill for 2013 and beyond. This is a development I will watch closely because it addresses the cost side of the equation.


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