So, since everybody wants to avoid the obvious answer to the question I posed in the diabetes thread, I thought I would consider a couple of slightly different angles. I get that for those right of center, there is this fabulous meme wherein it is believed that people will soon stop even wiping their butts because they will be waiting for someone in government to do it. It's not hard to accept the reality that if an individual doesn't have to work hard to survive, they are not going to do so. Well, except for the type A's of the world who live for the thought of killing or beating something or someone everyday. Nothing will change that meme. Still, as I move closer and closer to being an actual provider of health care making the shots on what tests, labs and medicines to order, I am seeing some insidious forces that I am not looking forward to dealing with.
The free market, like a recipient of government handouts, does not seem interested in working hard to produce the best outcomes. At least, they do not breed the best outcomes IF you believe a good outcome is helping a person live in such a manner as to not need medicine. In our market driven system, a patient will get whatever they want, whether it is actually called for or not. If you want an MRI, you will find someone who will give it to you who will word the note in such a manner to meet an insurance requirement and get them to offset the cost of your test. If you want an antibiotic, you simply brow beat your doctor until he gives it to you, or you go to someone else who will. This behavior has spawned a host of bugs that are now resistant to antibiotics they used to be sensitive to, all because people want antibiotics that are not required.
In the ICU, I took care of quite a few people who had a stent placed after a heart attack. Frequently, they had high cholesterol, or diabetes, or smoked. One lady I took care of was back within two months after vascular surgery to save her legs because she didn't stop smoking. For some people, that experience was a wake up call. But very often, I felt like I was participating in enabling people to live with very bad behavior. And as I mentioned in the diabetes thread, that illness is costing us hundreds of billions of dollars a year. Why are we paying that? Because it's what the participants in the market demand. If a doctor tells a patient they aren't going to give them something that isn't necessary, the patient will simply go to another doctor who will give it to them. If you don't give the customer (patient) what they want, you will lose money.
People complain about the high cost of medicine and for the next wave of "cost savings" they are going to fight to just pay providers less money, while still demanding they get everything they have right now. That is how free markets work, no matter how stupid the customer is and no matter how hedonist the behavior is that we are enabling, the customer is always deemed to be right. I think people like the idea of a doctor being a gatekeeper of the system, until they firmly believe they are being denied something they are fully entitled to because they have insurance, or because they read some article on the internet that is full of inaccurate information. My preceptor, so far, has been a fantastic example, he doesn't just tell people no without taking plenty of time to explain why. He doesn't need to do that, but he does it to protect both the patient and the system. If he was a true free market type, he would just give the patient's whatever they ask for, and I think he would be way way more popular.