No white sales in medicine, please or why taxing expensive insurance plans won’t work

Originally published in the Philadelphia Daily News, August 5, 2009
http://www.philly.com/philly/opinion/52498012.html

IN THE SEARCH for how to pay for health care reform, pundits and some senators keep talking about taxing employer-based health care benefits despite the fact such a tax would fall not on the wealthy – whose incomes shot up while their taxes were being sliced by the Bush administration – but on the middle class.

Taxing employer-based health care makes sense in theory – when things are cheaper we buy more of them. If everything but medical care is taxed, perhaps we do buy more of it than we need.

But I’m a community organizer as well as an academic, and I like to make the case for abstract ideas by telling personal stories. It struck me that among the hundreds of stories I’ve collected this year about people and their health care, I’ve heard none that support this theory.

Then I thought, organizer, organize yourself. And I recalled three stories of my own that illustrate this point exactly. Here they are:

In 1961, when I was 6 years old and living in upstate New York, my parents told me that I was going to have a tonsillectomy at the end of the week. “Why?” I said, “my throat is never sore.” My mother replied, “we were driving past the hospital and saw a big sign that said ‘sale.’ So we stopped and found that they had received a shipment of tonsillectomies from the city and were offering them at a 50 percent discount. You are going to need a tonsillectomy eventually – every kid here gets one. Let’s get it at a discount.” Almost every kid had gotten a tonsillectomy in my hometown by the age of 10. That’s how I had heard it was painful. So I started to cry. But then my dad said, “They are offering a special deal for kids, all the ice cream they can eat after the operation.” That satisfied me and I had the operation.

Thirty-three years later I tumbled down some steps after slipping on some loose cement near my office at the University of North Carolina-Charlotte. I had broken my shoulder and was dazed and confused when the paramedics came. But, luckily for me, the chart that gave prices and measures of effectiveness for every emergency room in the city was printed in big type with bold colors. So I was able to tell the ambulance to send me to the most cost-effective emergency room.

And finally, more recently, a cardiologist told me I had a funky EKG and said I might have a blocked cardiac artery. He then handed me a 60-page report with all the options. After reviewing my college statistics textbook, I spent six weeks digesting the material and decided to get a cardiac catheterization. I then waited for the end-of-year sale and got the procedure done for 30 percent off. It found an artery that was a little blocked. I asked the doctor whether that was unusual for someone my age nd he wasn’t exactly sure. So as I lay on the table, we had a long discussion about my options and, at my request, he gave me  few academic papers to read about them. I decided to ache block opened and a stent inserted.

These stories are, of course, false. I was taken to the nearest emergency room. My tonsillectomy may have been unnecessary. And, having looked at the evidence long after the emergency procedure–and not having any symptoms since–I’m a little dubious about whether the stent will extend my life beyond what diet, exercise and medicine would accomplish. The two procedures most likely won’t harm me and may do some good. But they were unnecessary, I did not have them because they were on sale.

These stories are preposterous not just because, like most insured people, I don’t make health-care choices based on price. Most of us don’t really make these choices at all, except to put ourselves in the hands of one or another medical professional who makes them for us.

We don’t want doctors to give us unnecessary, costly – and possibly harmful – care because our insurance will pay for it. But, we also don’t want them to skimp on care because our insurance will not pay for it. And that’s why the seemingly easy cure for the health care cost explosion, making insurance and health care more expensive, is utterly misguided.

Instead, we need to do the research to learn what works and what doesn’t work in medicine. Then we must build insurance, delivery, and payment systems that encourage the people who do make health care decisions – our doctors – to embrace best practices and optimal care for everyone.