Choice and Healthcare

Managed care plans, pharmacy benefit management companies, behavioral health managed care, capitation rates-physician incentives to see more patients, to see fewer patients, pre-approval for second opinions, non-emergency "emergency" visits, hospitalizations, pharmaceutical company purchase of prescription lists to use for marketing, wellness incentives, diagnostic related groups (DRGs). These are a few of the layers behind your choice of health insurance.

The purpose is to attempt to control your behavior (such as wellness incentives for stopping smoking or losing weight) or your doctor's behavior. For example, insurance companies (also known as PPOs, IPAs, HMOS and assorted other names) reimburse doctors by setting a target to see more patients or to see fewer patients by limiting physician visits or laboratory and other types of outpatient procedures.

As we debate whether we want all citizens to be covered by health insurance including a choice of a government health insurance plan, it turns out that we are actually limited in our choices. The choice that all of us want is for a relationship with our chosen physician.

Political scientists, (particulary John Kingdon) have described policy making as a process in which three streams come together a problem stream, a solution stream, and a political opportunity stream. The problem stream includes many problems that deserve attention but only some get on the political agenda and there are many solutions out there but only some get on the agenda. With the many problems out there to solve, many solutions to problems available, a political opportunity must be available to create a policy. When a policy window opens, all three streams come together. The window in the case of health care reform is the beginning of the new term of a president. The problem has been defined as too little health insurance coverage, the solution, some sort of universal health insurance, and political will to make it happen from interest groups, Congress, and the major proponent, President Obama.

I'm not so concerned about whether I have private health insurance choice or a government run plan. These choices are minor. I'm concerned that the way we run health care now and undoubtedly will continue to run health care has created a huge health insurance bureaucracy all in the name of cost control moving more and more people and agencies between me and my doctor.