The Covert Rationing Blog

Covert Rationing More Successful This Year

December 16th, 2007 by DrRich

According to a new Gallup Poll published on December 14, 30% of Americans admit to putting off medical treatment this year solely because they felt they could not afford the cost. Of those, 60% say the delay was for a medical condition that was very serious or somewhat serious. Results were based on telephone interviews with 1014 American adults, conducted between November 11 - 17, 2007.

Since similar polls were begun in 1991, when “only” 22% of Americans avoided healthcare because of cost, that percentage has steadily increased.

It is notable that 30% of Americans amounts to approximately 100 million individuals, which is more than twice the number of people who are famously uninsured. Therefore, over 50 million people who are avoiding needed healthcare must have health insurance.

Health insurance companies must surely rejoice at this news, which provides them with positive proof that their manifold policies and procedures, aimed at keeping the insured sick away from expensive healthcare, are working better all the time.

But, one might protest, isn’t this counterproductive in the long run? Won’t avoiding $100 of healthcare today lead to the need to spend $1000 on healthcare tomorrow? Indeed, the author of the latest Gallup poll, Magali Rheault, says, “While some demographic groups are more likely than others to report deferring medical treatment, whether for surgery, prescription drugs, or medical tests, such difficult decisions can not only have serious health consequences for individuals, but may end up costing more later on.” So isn’t the current state of affairs counterproductive to both individuals and to society?

This seems a reasonable surmise. But, DrRich suggests, people who ask this question miss the point. There are at least four reasons it’s better to save money today by foregoing needed healthcare, rather than trying for better care now and greater savings tomorrow. Which is to say, look at it from the insurance companies’ point of view:

1) It has never been proven that our spending a dollar on healthcare today ever results in our saving two dollars tomorrow.

2) Saving a dollar today impacts our profit/loss statement for this quarter. We’ll worry about next quarter during the next quarter. (A bird in the hand, etc.)

3) Early detection of some diseases - say, diabetes or cancer - just leads to very significant early expenditures, and if the treatment is successful, often to chronic, long-term expenditures. In contrast, not making an early diagnosis of such diseases may lead to a burst of later expenditures - but again, that’s later. And since the disease will have progressed significantly, often the long-term expenditures are, shall we say, limited by nature.

4) The fact that patients are voluntarily foregoing medical therapy for very serious or somewhat serious illnesses effectively replicates the rationing methods used in Canada or Great Britain. That is, it creates a virtual queue, whereby patients who clearly need therapy are “waiting” for treatment. Waiting for different reasons, to be sure, but waiting nonetheless. And surely, voluntarily waiting is less un-American than waiting imposed by oppressive governmental authorities. In this light, our policies can only be seen as patriotic.

And so, the notion that it’s a fiscal tragedy to multiply tomorrow’s healthcare expenditures by forgoing a bit of expenditure today probably doesn’t impress the insurance companies very much. Whatever else may be broken about their business model, for patients to voluntarily avoid needed (and often covered) healthcare is a form of covert rationing that saves the insurers substantial and growing amounts of money each year.

Besides, it’s like the insurance companies always say: Patient choice - that’s what it’s all about.

Posted in Gekkonian Rationing

9 Responses to “Covert Rationing More Successful This Year”

1. SamEyeAm wrote on 12/16/07 at 11:37 pm :

   Two blind men feel different parts of the same Elephant. Dr. Rich it is frightening how each persons “neural lens” focuses the same core issue in a different way. Read what Mr. Jaffe of the Chicago Tribune writes: http://www.chicagotribune.com/news/opinion/chi-oped1207insuredec07,0,4358923.story

   Also I am pasting my response to his article below. Your comments about deferring problems that become “limited by nature” is far kinder than the blunt instrument i typed: If they (patients with problems) dont show up for routine mammograms, colonscopys etc…. well hospice is alot cheaper than intense surgery, chemo, and radiation therapy with all its attendant complications.

   Dr. Rich I am worried that I will have to stop reading this blog. The grand unification theory and your observations are overwhelming me like a child with sensory integration disorder. I am starting to feel like my 4 year old son when he becomes over-stimulated.

2. Marilyn B. wrote on 12/18/07 at 5:36 pm :

   I offer another reason I avoid taking only the most critical needs to the doctor. I am afraid to build a record of problems because as I get closer to retirement age I realize I will make myself uninsurable should I seek to maintain private insurance rather than jumping into the Medicare fiasco.

   I hear insurance companies are digging into patients’ records looking for any obscure clue by which they can accuse a patient of failure to disclose. They then cancel insurance policies of people who look like they may be developing a costly condition.

   Rationing is going to happen one way or another, it just isn’t clear who are going to be hurt the most.

3. DrRich wrote on 12/18/07 at 7:03 pm :

   Marilyn,

   “Rescission” is what the process is called when health insurance companies retrospectively cancel policies of patients who suddenly become loss leaders (i.e., who suddenly get seriously sick). It’s a well-honed process in the industry. Here’s an article that describes a little bit about it:
   http://covertrationingblog.com/general-rationing-issues/one-hell-of-an-exit-strategy

4. Marilyn B. wrote on 12/18/07 at 11:33 pm :

   Thank you for the link, Dr. Rich. All I can say is “wow.”

   Scary to see my current insurer as the antagonist in this article.

5. R Alanko MD wrote on 12/20/07 at 2:05 am :

   You can add
   5) the patient may have changed to another company or to Medicare by the time the preventable condition hits the fan.

   BTW, I’m not convinced any money is saved by much of preventative care and I distrust arguments based on a nebulous “saves money in the long run”. Appropriate prevention is often not cheap but still necessary despite the cost. Almost any procedure is more expensive than a casket.

6. SamEyeAm wrote on 12/21/07 at 1:09 am :

   Dr. Rich,
   It looks like the military has found a way to ration health care, benefits, and recoup expenses.

   http://www.thenation.com/doc/20070409/kors

   Many people love to site the military hospital system as well as the Veterans Affairs medical system as paragons of national healthcare.

   I remember what a vet told me about the shiny new VA hospital clinic that I rotated at as a resident. “Just the same old whore in a new dress”

7. SamEyeAm wrote on 12/21/07 at 1:16 am :

   Dr. Rich,

   One more form of great rationing. Workmans comp. One urine drug screen and you lose all your benefits. In Florida the burden of proof to recover your benefits falls on the employee. Denial of benefits, job termination effectively leaves most people with little or no care at the worst possible time, a life or limb threating injury. The review legal process takes months. All disguised in the form of the “drug free workplace”.

   Sam

8. DrRich wrote on 12/21/07 at 12:15 pm :

   Sam,

   Thanks for the link to this outrageous story. Wounded military are the last people who should be subject to healthcare rationing.

   DrRich

9. SamEyeAm wrote on 12/21/07 at 7:22 pm :

   Dr Rich,

   I have become highly vigilant regarding my own health care. One possibility of people not using their insurance is that they are trying to stay “off the grid” For example, I wont call my car insurance company for a repair of a few thousand dollars simply for fear of estabilishing a high risk record. I think the same thing is happening with folks and their insurance. Perhaps not for big ticket items but for smaller exams which might be fodder for benefits/policy denial staying off the grid would be key. Recently we changed insurance companys and received a letter requesting information on any out of pocket previous health expenditures (under our prior plan) that could be included in meeting our current yearly deductible? I told my wife to cease all forms of communications with the insurance company. Why would an insurance company care about my prior out of pocket expenses and be so considerate to include out of pocket health expenses towards this years deductible under an insurance health plan that we were not contracted with at the time the expenditures were made? Can you say denial for pre-existing conditions? I am beginning to feel like a lawyer. SAY NOTHING, SIGN NOTHING, DO NOT LET ANYONE RECORD A CONVERSATION. Paranoia is another sign of health care rationing prey.

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