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Healthcare Scenarios Michael Arnold Glueck and Robert J. Cihak , The Medicine Men Wouldn't it be nice if you could spend your own money on the medical care you want — not on what other people think you should get? When the bureaucrats get involved — watch out. There are four basic scenarios, defined by whose money and whose benefit, for providing medical care. Scenario 1: Spending Your Own Money on Things for You In this scenario, you choose what goods or services you want for yourself. You can shop for the medical care you believe provides the best value which means selecting your doctor and, with his guidance and advice, selecting a course of treatment. The decisions are between you and your doctor and you pay the doctor for services rendered. It's the "old fashioned" doctor-patient relationship. If you believe you are getting too little care or paying too much, you go elsewhere. Costs may be subsidized by employers, insurance companies, or government agencies but the decisions are yours. Scenario 2: Spending Your Own Money on Things for Others In this scenario, you choose what goods or services you want to provide for someone else. Selecting and providing medical care for minor children and medical or assisted-living care for elderly relatives fall into this category. Your choices may not provide exactly what the recipient wanted but they reflect what you believe to be the best value. Costs may be subsidized as in Scenario 1. Scenario 3: Spending Other People's Money on Things for You Story Continues Below
In this scenario, you choose how to spend someone else's money on goods or services for yourself. People fail to appreciate the real costs since insurance premiums are paid by the employer and are frequently not even known to the employee. There is little or no patient cost to visiting a doctor therefore there is no incentive for judicious, cost-efficient use of the medical system. People expect only the best of care and are disappointed if constraints are imposed. The doctor-patient relationship is compromised. To combat over-use and control costs, insurance companies set allowable costs in which there is no differentiation between a procedure performed by a newly licensed doctor and the same procedure performed by a world renowned specialist. Bureaucracies are created to monitor and judge the doctor's treatment even though the bureaucrats have never examined the patient. Scenario 4: Spending Other People's Money on Things for Other People Someone else decides how to spend money that is not theirs on goods and services for someone else. Universal Health Care, which falls into this scenario, typically requires that the power of taxation be used to take money from people to be spent on medical care for someone else. Rules are made that limit choice. These neither permit flexibility for the unique aspects of an individual nor allow the patient to be a key decision maker in his own treatment. So it seems to us simple souls that, in terms of medical care, Scenario 1 is the best and most efficient use of your money and Scenario 4 the worst. This "Four Scenario" concept is not original; libertarians have long recognized that these principles apply to many entitlement and regulatory programs including Social Security. Unfortunately in city, county, state and federal governments Scenario 4 prevails much too often. Elite political officials think they are better equipped to determine what is good for you than are you. They believe government mandates are superior to offering rational arguments that convince a majority of citizens to freely adopt their objectives. Frequently distortion and propaganda is used to justify their mandates. Finally, most of the 535 elected members of Congress are Scenario 4 personalities even though they are part of a government that was intended to be by the people, for the people and of the people. Something to seriously think about. Editor's Note: Michael Arnold Glueck, M.D., wrote this week's commentary. He thanks Thomas R. Damiani, business and technical consultant, Newport Beach, Calif., who contributed to this column. Contact Drs. Glueck and Cihak by e-mail. Michael Arnold Glueck, M.D., comments on medical-legal issues and is a visiting fellow in Economics and Citizenship at the International Trade Education Foundation of the Washington International Trade Council. Robert J. Cihak, M.D., is a senior fellow and board member of the Discovery Institute and a past president of the Association of American Physicians and Surgeons. Editor's note: Read more on this subject in related Hot Topics:
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