Tuesday, February 21, 2006

Only the Best Possible Care?

During a recent discussion about health insurance, a friend told me that "whatever the most effective treatment is, that's the only option that should be available."

I disagree with this sentiment for two reasons:

1) It's impossible to implement and maintain, and

2) It's not something we as health care consumers actually want.

The reasoning for the first argument is pretty obvious. How could you possibly control the number of treatment options for any given condition? You could try making any form of treatment other than the approved option illegal, but that's not likely to stop doctors from performing them. Besides, we've all seen the horrendous outcome of outlawing things people want (prohibition, the War on Drugs, and gun control laws all come to mind).

There are a couple of reasons, though, why we wouldn't want there to be only one option...no matter how good it is. The first of these is price. It's likely to be high. A monopoly granted on only one form of treatment, or one product, or one service won't necessarily cause the price of that thing to increase immediately, but it will prevent it from decreasing as it normally would with the introduction of new technologies and more efficient processes. Sure, many companies may try to find ways to provide the same thing at a lower cost, but their efforts would be subject to scrutiny by whatever government agency oversees their particular market. This would add cost to the final product and delay its time to market, thereby reducing the incentive to innovate.

Also, by limiting consumer choice to only one option, many consumers would be priced out of the treatment they need. For instance, if a law were passed that said only the largest television with the best possible picture could be sold to consumers, many people would go without TVs, as not everyone would be able to afford the biggest and best. Since, however, there are myriad television choices available to consumers at varying prices, nearly every household in the United States has more than one television. An increase in consumer health care choices will, through competition, cause prices to decrease and quality to increase.

Radiology: Marketing Out of Control?

You've seen the commercials, particularly during the Olympics this year, hawking state of the art medical imaging equipment. They feature doctors crowded around computer monitors, looking at spinning 3D models of bones or internal organs. It's all very high tech, cool-looking, expensive stuff...but is it useful?

I learned today that, for the most part, it isn't.

According to the radiology doctors at National Imaging Associates (a radiology services company), the 3D models provide little or no additional useful diagnostic information than the typical segmented images already produced by medical imaging equipment. In reality, all the 3D software is doing is taking those segments and stacking them atop one another to form a 3D image. It looks cool on the screen, but it can hide details that would be easily seen on the flat segmented images. Besides...it's really freakin' expensive.

From a marketing standpoint, though, the software is worth its weight in gold. Not only does it help sell imaging equipment (the usefulness of which is undeniable), it also gives care providers some additional whiz-bang functionality that they can use to attract patients. It may even boost patient confidence in the quality of treatment they receive.

In the end, however, the utility of the equipment becomes largely irrelevant when considered within the framework of our current health care and insurance system. If care providers spend millions on fancy software and equipment, the resultant increase in the cost of care will be hidden from consumers by health insurance, since the costs will be paid out of the pool of funds taken in by the insurance company through premiums, rather than by the individuals receiving treatment.

And herein lies one of the greatest reasons for increasing health care costs. When was the last time your doctor gave you an option between two or more forms of treatment, citing differences in cost as a possible determining factor in your decision? It's probably never happened to anyone who has health insurance. Even when there are several treatment options of similar effectiveness that vary in cost, doctors and patients typically choose the "best" and usually the most expensive treatment...often without hesitation. If patients were paying the bill directly, they would take more time to weigh their options, and fancy but mostly useless software and equipment would be weeded out of the market.

Wednesday, February 01, 2006

Bad Law, New Twist

When did it become okay for politicians to tell a store what it must sell? It's bad enough that they can tell retailers what they can't sell, but this is a new one on me.