Health Care Revisited

, I was pretty enamored with the HK health care system.  Then I got insurance.  Now there’s a for-profit corporate middle-man between me and my doctor who has a financial interest in giving me as little health care as possible.  Feels like home.

I’ve been having pain in my left foot that’s been getting progressively worse.  After jumping through a few hoops designed to make it difficult for me to see a specialist, I finally acquire permission from my insurer to see an orthopedist.  So I go to the orthopedist, and he thinks it’s tendinitis, but wants to take an x-ray to rule out any damage to the bone before he treats it with a steroid injection.  Sounds reasonable.  But before I get to the x-ray, one of the nurses informs me that my health insurance won’t pay for x-rays.  This seems unbelievable to me, so I spend the next hour or so on the phone with the insurance company fighting to talk to someone with a brain.  (Making it really difficult for me to talk to anyone is obviously in their interests.  After all, I might just give up and not get treatment, which is the best possible outcome from their standpoint.)  I finally get someone with a partially functioning brain, who can do slightly more than repeat the same nonsense over and over.  He informs me that they might pay for my x-ray, but that I have to pay out of pocket first and then submit the receipt.   (The hope here is that I’ll find the paperwork so onerous that I’ll just give up and pay for it myself.)  Then, if the insurance company bureaucrat decides that my doctor gave me the x-ray in order to “treat or diagnose an injury or illness,” they’ll pay for it.   Well, of course it’s to treat or diagnose an injury or illness!  Do people get recreational x-rays?  Isn’t my doctor in a better position to make this medical decision than some mindless corporate stooge?  I’ll submit the receipts, and then they’ll try as hard as they can to figure out a way not to reimburse me.

I think the HK health care system is about as good a system as you can have, without cutting the insurance companies out entirely.  Unlike in the US, the x-ray was somewhat affordable even without insurance (about $40 US).  But my recent experience reinforces my belief that the profit motive needs to be removed from the system.  I’d much rather have a democratically elected government between me and my doctor than a heartless corporation.  It’s all about incentives, and the incentives in the employer based health insurance system are all wrong.

The US has “reformed” its health care system.  Even these reforms won’t make it as good, or as fair, as the system in HK (costs still way too high, and still way too many uninsured people).  The incentives haven’t changed.  The difference is that there are a few more regulations in place that won’t allow insurance companies to be quite as evil as they were before the new law was passed.  But they’re actively looking for ways around those regulations.

This is one place where the free-market fundamentalists are simply wrong. The profit motive is a powerful incentive.  But we need to look at what kind of behavior it incentivizes.  The profit-motive can encourage hard work and ingenuity.  It can also encourage environmental destruction, and other methods of socializing costs while privatizing profits.  In the case of health care, the profit motive incentivizes insurance companies to act like assholes.  If they stop acting like assholes, they make less money.  Rather than efficiency, it incentivizes deliberate inefficiency.  No amount of regulation will solve that fundamental problem.


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