Freedom

by digby

Well at least we don’t have long waits and rationing like all those other horrible places:

In Framingham, Dr. James Kenealy, an ear, nose and throat specialist, said his patients increasingly cite copayments as a hurdle to continuing with allergy treatments. The care typically includes weekly shots for several months, with copayments ranging from $20 to $50, per shot, depending on the patient’s insurance plan.

“Probably once a week, there will be a patient deciding to discontinue allergy injections or not pursue that as a therapy because they have high copays,’’ Kenealy said.

Even patients without chronic illnesses are finding themselves in a copayment crunch.

“If you are a family with four or five kids . . . copayments are going to add up,’’ said Worcester family physician Dr. James Broadhurst, noting that children visit doctors frequently for illnesses and preventive care.

Especially in the past year, Broadhurst said he’s encountered more families asking him to treat or prescribe over the phone because they can’t afford the copayment of an office visit.

As part of Massachusetts’ pioneering 2006 healthcare overhaul, the state created the Safety Net program, which helps people of any income pay large medical bills. But it specifically excludes coverage for copayments.

“Oftentimes, these people end up using their credit cards to pay their copays and end up with medical debt,’’ said Kate Bicego, help line manager at Health Care for All, one of the state’s largest consumer groups.

Bicego said calls to the nonprofit group’s helpline are up roughly 65 percent from last year, and many of those seeking help are struggling with copayments and deductibles.

Other countries have systems that prioritize health care treatment on the basis of need — a triage system. We prioritize health care on the basis of who can pay. And in the most perverse form of rationing there is, we make the sickest people have the most difficult time getting access to health care. (The sickest, after all, can’t hold down a job, so the employer based system doesn’t really work for them, at least not in the long term.)

The idea that the US doesn’t ration health care is absurd. We certainly do. We just make people do it to themselves out of economic hardship. I guess that’s supposed to be a tribute to our sense of individualism and personal freedom.

Hey, nobody’s going to tell you you can’t be treated — you made that decision all by yourself when you opted not to have a lot of money. That’s what freedom’s all about. (Unless you’re sick and you want to die, of course, in which case the state won’t let you.)

The debate is really about irrational rationing vs rational rationing — and the US is the undisputed leader of the first method. When we set our minds to it, nobody can be as irrational as we are.

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