Reply #49: Example

[Psephos]

You wake up with a runny nose and mild fever. You are catching a cold. You go to the doctor, and ask for antibiotics. Doctor gives you a Z-Pac (erythromycin 7-day supply), even as she tells you it's not likely to help. Much easier than having the same argument she's already had with the last 50 runny-nose people. If you went to the E.R., you just spent $500 on $5 worth of medicine that won't help. But it's not your $500. If you went to a GP, then it's more like $100 or $200. But probably not on the same day that you called.

Colds are caused by rhinovirus. There is no antibiotic that can help you.

Or this. Your back has been hurting again for the past few weeks, but on Saturday it feels worse, and on Sunday it's no better. You go to the E.R., where they put you through the routine of hisotry, physical exam, x-ray, ortho consult, etc. They tell you that with a herniated disc history, you have to accept that there will be periods of more pain and less pain in your future, just as your back specialist has told you previously. You want more than words. The E.R. doc needs to move on to the laceration repair in the next room asap, so hands you a prescription for Flexeril and another for Vicodin, despite knowing that it's just another kick of the can down the road. You walk out satisfied, leaving a $1400 bill behind.

Etc.

Much of the waste comes from two sources.

1. People have been conditioned to seek medical care for routine ailments and chronic conditions. Many, perhaps even most, routine visits solve no problem and are not medically necessary. There are far less expensive ways to deal with most of these problems.

2. Physicians practice defensive medicine, ordering more tests than needed, more procedures, more medicines, because it helps ward off undeserved malpractice actions.

Stats I've seen say over 80% of physicians admit to defensive practices. Spend a day at the E.R. observing and you'll soon understand how many emergencies are treated vs. toothaches, backaches, and runny noses. Figure five hundred to a thousand bucks a pop on each case and it's clear why free isn't as good as a small, reasonable cost to incentivize good stewardship. They charge five dollars at the local "free" clinic for the uninsured and I'm told that number works best for their demographic to encourage conscientious consumption.