A couple of weeks ago Sarah Palin talked about the "death panels" she saw in some of the health care bills being considered by Congress. As with most things former Governor Palin says, this created a lot of controversy. Many people ridiculed Ms. Palin, though Senator Chuck Grassley got the provisionin question deleted from the bill he is working on with Democrat Max Baucus and four other senators (two Democrats and two Republicans) because it could be "misinterpreted or implemented incorrectly."
One commentator who ridiculed Ms. Palin was Froma Harrop, who wrote about her experiences with a "death panel" here. It is a sad story, and one does not like to criticize somebody who went through something like this, but in light of my poston "Why I Don’t Like President Obama’s Health Plan", I did want to make a couple of comments on Ms. Harrop’s article.*
First, I can see how Ms. Harrop’s experience would make anybody want to try some other system. It is hard to see how her situation could have been much worse. However, while Ms. Harrop’s situation did involve private health care (as opposed to a government plan), note that Ms Harrop was not in a PPO or fee-for-service plan which most likely would have allowed her husband to see the doctor he wanted to see. Unfortunately, she and her husband were in a HMO. (This becomes clear near the end of the article.) And the HMO decided, for Ms. Harrop’s husband, that adequate care could be provided by a small, local hospital. Except that Ms. Harrop and her husband knew this was not true. But since they were in an HMO, their options were limited.
As I mentioned in my post, when I did not feel comfortable with the eye care I was getting in an HMO, I was luckier. Mine was a minor issue at the time it first arose. More importantly, my employer offered a PPO option that I could switch into, and I had time to do so. It does not appear the Ms. Harrop and her husband had that option – or the time.
But the point is that their problem was not because they were in a private plan versus a public plan. It was the kind of plan they were in. If they had been in a fee-for-service plan, regardless of whether it was public or private, they probably could have gone where they wanted, right away.
But they were in the kind of plan that limits the patient’s choice with respect to the doctors they can see. That is inherent in an HMO, regardless of who is paying the bills. In fact, it is this limitation on patients’ rights to see whatever doctor or specialist they want to see (or to get whatever treatments or medicines they want to get) that is one of the reasons some people believe a HMO, or similar plan, can help reduce health care spending. They think this kind of plan can help reduce waste. The problem is, one person’s "waste" is another person’s essential medical care.
Two other thoughts. First, when Ms Harrop says that a bureaucrat (she means a public bureaucrat) "would have given a simple ‘yes’ or ‘no’ based on official guidelines," she is being unrealistic. She and her husband were dealing with an unhelpful bureaucracy at their HMO. While their situation was horrible, there are plenty of unhelpful bureaucrats in government, too.
Second, she says that "a government-run program doesn’t tell you what treatments you may or may not have. It tells you what the taxpayers will subsidize. You are free to go out with your own money and buy whatever you want." Well, maybe. It depends on the public plan, and it depends on whether there would be doctors available outside the public plan.
There is no guarantee that, if we had a big public system, the doctor Ms. Harrop and her husband wanted to see would have been able or willing to see them. When doctors are in a public plan, it often happens that they are not allowed to see private patients. Or if they are allowed, they can’t charge the private patients any more than the government pays them for the same service. If a doctor can’t charge private patients a little more, why should they go to the hassle of seeing them? Why not just see the patients the government sends you and not have the work of billing and collecting and all that?
Ms. Harrop tells a terrible story. But it is not the whole story. The key, in any case, is this: As Congress considers all kinds of various health care proposals, let us hope that they, in trying to make things better, do not make them worse.
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* At some point, if I can fit it in between work and life, I want to look at what President Obama said this subject back in April (in an interview with David Leonhardt of The New York Times) and compare what he said with some thoughts/experiences I had. It may be a couple of weeks, but I will try to get to it. It doesn’t look like there will be that much baseball to distract me.
Update (8/25/09 12:55 p.m.): Fixed two typos in the second to the last paragraph. (Question: Why do you see those things only after you hit "publish"?)
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