More Waiting

Mark Kleiman has a totally non-funny story about how, yes, you need to wait to get health care in America and, consequently, he almost died. The punchline is here:

It was only later that I discovered why the insurance company was stalling; I had an option, which I didn't know I had, to avoid all the approvals by going to "Tier II," which would have meant higher co-payments. The procedure is designed to get very sick or prosperous patients to pay to jump the queue.

The insurance company almost killed a man in order to try to persuade him to buy more expensive services.

Comments

"The insurance company almost killed a man in order to try to persuade him to buy more expensive services."

12:12pm, July 13th. When Matt abandoned any pretense of nuance or writing fairly about different positions on health care financing. Health care now joins Iraq as an issue where you have a fixed position and everyone to the right of you is an idiot. Point taken.

Posted by Fred | July 13, 2007 12:42 PM

everyone to the right of you is an idiot

Well, yeah.

Posted by latts | July 13, 2007 12:51 PM

I donno Fred. It may be a passionate headline but it is an accurate statement to this situation, so your complaint seems melodramatic.

Posted by Northern Observer | July 13, 2007 12:58 PM

Poor Fred. It's so hard being the only reasonable guy in the room.

Posted by Steve | July 13, 2007 1:03 PM

Fred: "When Matt abandoned any pretense of nuance or writing fairly about different positions on health care financing"

The more pertinent question would be: in what universe SHOULD we be fair to an organization that tries to encourage upcharges by playing chicken with somebody's health. Maybe, TO BE FAIR doncha know, we should point a gun at Fred's head and let someone else make a decision about whether or not to pull the trigger. Since Fred thinks there's some nuance here, I'm sure he won't mind.

And no one has yet noted that hospitals and Doctors frequently start sending out bills before the final word comes back from the insurance company. I believe the insurers are hoping we'll be dumb enough to pay the bills sent out because after 90 or 120 days some kind of bill has to be sent out from the health care providers.

Posted by Doug | July 13, 2007 1:10 PM

It's not unreasonable that the insurance company would charge more for better service with fewer restrictions. Kleinman's problem (and what really almost got him killed) was that he didn't understand his coverage options. If he had, he wouldn't have had to wait. I don't think that's the insurance company's fault. The real injustice is that someone who couldn't afford the more expensive option would face the risk of death by delay.

The system is clearly screwed up and I'm in favor of anything that simplifies it and provides something close to universal coverage (if not universal coverage itself). I'm not in favor of demogogic demonization when the problem isn't evil people but bad institutional design. Some nuance please.

Posted by Led | July 13, 2007 1:13 PM

Led. I would agree with:

when the problem isn't evil people but bad institutional design

IF "bad institutional design" wasn't in place and kept in place BY DESIGN by the aforementioned "evil people".

Posted by BlueStreak | July 13, 2007 1:17 PM

Kleinman's problem (and what really almost got him killed) was that he didn't understand his coverage options. If he had, he wouldn't have had to wait.

That is wrong. If he had understood his coverage options better, he would have had to pay more money in order to avoid waiting.

Is there any good reason to structure coverage in this way? Not that I can discern. The only reason to build the delays into the cheaper tier of coverage is get people to pay more. Imagine an airline that offers two cabin classes, First and Coach, but the only difference between the two is that the flight crew stands at the bulkhead and whacks the passengers in Coach with hammers as they board and exit the aircraft. This airline surely could extract additional profits from the people willing to pay to avoid being whacked, but that doesn't mean that the public is better served -- indeed, quite the opposite.

And if you set that all that aside, you have a particularly poorly designed insurance regime here, one that is designed to structure incentives to induce the sick and the wealthy to pay more to avoid delays, but that is so opaque that even a fairly accomplished professor of public policy does not understand until later that those were the incentives. A market with such formidable transaction costs is not going to work very well.

Posted by Tyrone Slothrop | July 13, 2007 3:03 PM

I'm sorry, but is this rhetoric really appropriate for people arguing that we should move to a more transparent way of killing people by delay?

Posted by Thomas | July 13, 2007 3:05 PM

Well after hearing that story I almost feel guilty complaining about my wife's experience. Her period went on for 6 weeks before she could get into the ob/gyn. Thankfully, it was nothing serious.

Frankly, I don't give a damn whether some elitist, Harvard debate rules find the "argument by anecdote" illigitimate. I hope the Harvard graduates who work for health insurance companies are profoundly ashamed of their employers' "Harry and Louise" ad campaign.

The truth is that the insurance industry said lots of bad things would happen if the Clinton plan were adopted: long waits, loss of choice, denial of claims, increased prices, lack of competition, blah, blah, blah.

All those bad things ACTUALLY HAVE HAPPENED without any national health plan. They've been perpetrated by the exact same industry that defeated the Clintons' attempt. So more anecdotes please, and the Harvard debate squad be damned.

Posted by Jalmari | July 13, 2007 3:28 PM

Fred,
Sometimes killing people is legal and profitable. In those cases, people who's sole justification for their salary is to maximize profits will recommend that the killing take place. I realize that the world would be a happier, shinier place for you if this were not true. I would prefer that it not be true as well, but I prefer knowing the truth to knowing a pleasant lie.

Posted by Njorl | July 13, 2007 3:47 PM

To be fair, the insurance company isn't killing anyone. But they are intentionally making more likely that customers will die because before they can receive appropriate medical care, and over a large population of customers this will mean that more customers will die.

Posted by Tyrone Slothrop | July 13, 2007 4:07 PM

Here's another data point: this afternoon I scheduled some elective, non-cosmetic surgery with a specialist in New York. First available surgery date: January 7, 2008.

I know they saw that New York is the most European of American cities, but really . . . .

Posted by jlw | July 13, 2007 4:20 PM

When Matt abandoned any pretense of nuance or writing fairly

You know what, Fred? Tell it to the Clintons, Al Gore, John McCain's adopted Bangledeshi child, and John Kerry.

As Republicans are so fond of reminding the poor and those who lost jobs due to economic realignments: life in unfair.

Posted by Tyro | July 13, 2007 4:39 PM

Fred is just trying to shift the focus. The point is, people who cite "long waits" as a reason to oppose government operated health care are incorrect, because there are "long waits" for may actors in this system as well. Thus, its not a legitimate objection.

Posted by Father Figure | July 14, 2007 11:35 PM