[ExI] USA Health Costs

Stathis Papaioannou stathisp at gmail.com
Wed Jun 3 11:15:27 UTC 2009

2009/6/3 spike <spike66 at att.net>:

> Hmmm, depends on how one defines the term "need."  Do we need airbags in our
> Detroits?  People who have a ton of money might argue that we do, or that
> they are a good health investment.  Others disagree.  If one saved money by
> not having an airbag, perhaps one could afford to move to a neighborhood
> where she is less likely to be slain by the local thugs for instance.  The
> airbag/slum paradigm is a good way to view the question of the medical
> establishment overtesting.

Unlike airbags, medical treatments and even tests can have adverse
consequences separate from their financial cost. Every treatment has
possible complications, and every test has a false positive rate, and
may lead to more tests and potentially dangerous procedures.

> The doctors have a hell of a difficult job.  They must decide on what
> medical tests are a good value to the patient.  If so, do they take into
> account if the patient has medical insurance?  I would think so, for if they
> recommend an expensive test which offers some (but not a lot) of risk
> reduction, they may be pricing the patient out of her airbags, or into a
> more dangerous neighborhood for instance.  But if the patient has insurance,
> then it wouldn't remove their airbags or move them into the poorer more
> dangerous hoods.  Tough question.  I am glad I decided against medical
> school.

This is the sort of decision doctors make all the time, and there are
guidelines based on research for what tests and procedures should be
performed in a particular situation. In general, doctors and insurance
companies tend to follow these guidelines. A doctor is not supposed to
order a completely frivolous test just because the patient wants it,
for example, at least not while lying to the insurance company about
the test being necessary.

Most private doctors I encounter don't overservice, not because they
are afraid of the government or the insurance company, but because of
a sense of professional ethics.

Stathis Papaioannou

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