After dropping my car off at the dealer for service, my ride to the hospital was provided by a 69 year old retiree named Dave who works till 10:30 every day (where do we sign up for that?) and then goes off to the range to shoot rifle and pistol. After finding out I was a doctor Dave gave me an earful about how Obamacare is going to provide health care for nothing to all those freeloaders, and got another earful about his own experiences with the greatest health care system in the world. As the result of a minor abnormality on a "routine" electrocardiogram last year (a screening test widely discredited as unnecessary and sometimes harmful) he was sent to a cardiologist for further testing. A $2500 nuclear exercise test was normal. A screening test for prostate specific antigen (also discredited) led to referral to a urologist who did a rectal exam and mercifully told Dave to go home and forget about it. Even though Dave's blood pressure at home averages 125/85, an office measurement of 140/95 led to a branded prescription which the local Walmart priced out at $53. Dave left the script at the pharmacy counter.
Aside from finding Dave a doctor who will listen to him, I couldn't help but be reminded once again, of your lesson on the power of incentives. Dave's doctor gets about $80 for a 15 minute office visit. Out of her revenue stream she must pay the rent, utilities, cost of supplies and salaries of her office staff. Whatever's left belongs to her, which for most internists averages out to around $185 K a year. If she adds an electocardiogram to every visit, (cost around $100 for the test itself plus her interpretation of it), she more than doubles her income for that visit. She is, as Dave pointed out, a small businesswoman, and as such her goal is to minimize loss and maixmize profit. If I had embraced the business model of medicine by going into practice, I'm sure I would have done the same.
Test by test, pill by pill, this is how we got to 17% of GNP, and rising. It doesn't help, as you have noted previously, that consumer/patients are effectively separated from the experience of paying for the tests that their doctors order for them
Meanwhile, the trip to the car dealer for an air bag recall has led to a $900 bill for "necessary maintenance"
Its a great country we live in.