Thursday, May 6, 2010

“Why wouldn’t your staff give me medication samples?” my patient asked me after the fact. “Well,” I explained, “you have insurance. We try to reserve what limited samples we have for those who really need them.”

“Well, I should get some; I’m on a fixed income,” my patient replied. This is a sentiment heard frequently in my practice as a family physician. So many seem to think they are entitled to something free. (To be clear, I am not referring to access to appropriate care.) This thinking has led to our current health care crisis and the passage of a government solution, but there is a better way.

Where did this entitlement thinking come from? Only a generation ago, everyone expected to pay his or her own medical bills. There were charities for the poor, but no one expected care for free. With the advent of modern health insurance, the patient became separated from the true costs of health care. Patients began to accept the idea that insurance would cover such routine things as office visits and preventive physicals. They began to get these services for “nothing” or for a tiny co-pay. No longer was the actual cost an issue - as long as it was covered. A common statement I hear is that patients want to get “everything checked” because they have insurance. The idea of paying for a service outright has become so foreign that even we as medical professionals don’t believe in it. If a particular medication or test is not covered by the insurance company, we tell patients that they cannot get it. Of course, they certainly could get it by paying for it.

Under this system, costs inevitably rose. Because the true costs were hidden, patients did not seek to spend wisely; they sought to get the full benefit of their insurance. It is like being in a jeweler’s shop and being told you can pick anything you want for a mere co-pay. Who wouldn’t choose the most expensive diamond? Of course, someone had to pay these rising costs, and so co-pays and premiums rose.

The expectation of nearly “free” health care in the face of rising costs led people to demand health care reform. Few understood what was involved, but most knew they wanted lower costs. Every day I hear from patients angry that they must pay more of their premiums themselves or that their co-pays have gone up. Then came liberals with their perennial promise of unlimited health care with lower costs - compliments of Uncle Sam. We need health care reform.

Contrast this entitlement mentality with the attitude of another patient I saw recently. “Is that on the $4 list?” he asked as we discussed a medication I was recommending. After I assured him it was, he explained that he was self-employed and did not have health insurance. My patient was not rich, but he came for a preventive physical. He was not expecting a handout but was looking to save any way he could.

This second patient of mine represents a better pattern for health care reform, but Obamacare punishes him. He will be fined if he does not get insurance. The insurance he will be required to get may be too expensive for him and cover what he does not want. Never fear, there are subsidies; after all, he deserves these things, even if he does not want them. He will not be encouraged to spend wisely; his care will be covered. In fact, Obamacare will set the limit on how much he can pay out of his own pocket. Instead of rewarding responsibility and accountability, the new health care reform law rewards the entitlement attitude that got us to this crisis. Let’s repeal this terrible law and return patients to the place of accountable consumers who understand the true cost of their health care and that it is not free.

Dr. Paul Dibble is a family physician in private practice in Wyoming, Mich.

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