The Illusion of “Other People’s Money”

The problem with healthcare, and drug prices, in America isn’t that we spend too much money. The real problem is that we believe we are spending “other people’s money”.

Yes, I was raised in Sweden, but no, I’m not a Socialist. But the irony is that “free” healthcare there is more clearly understood to be directly financed by local(!) taxes that can go up if people in that region consume more healthcare. Here, nobody really knows what anything healthcare related actually costs, or who pays how much, so how can we really care about the cost of healthcare?

Here, most health insurance is financed by employers, and I don’t believe the average American worker is lying awake at night worrying that his family’s medical bills will eat into the corporate profits of his employer. And even if American workers bear some of the costs of their health insurance, the relationship between how much healthcare they consume and how much their portion of the insurance premium will go up is less than obvious, depending on who else is insured in the same risk pool as each particular worker’s employer sponsored insurance.

The Swedes have, in spite of their minimal churchgoing, a set of ethics that relates their personal choices to the impact they have on society as a whole. They recycle batteries instead of throwing them away, they worry about air pollution – so much that it is illegal to idle your car for more than 60 seconds, for example when the bridge over the canal in my home town opens to let a tall ship through. My former countrymen also care deeply about how waste in the healthcare system can affect the availability of healthcare for vulnerable people.

Another thing they are more sensitive about than we are over here is corporate greed. The examples on this side of the Atlantic are so many, and occur so frequently that we soon forget each individual case. What we do retain is the regrettable sense that healthcare is a dirty business where someone is always taking advantage of someone; providers cheat Medicare, insurers cheat patients, drug companies cheat them all.

What we need in this country is a moral wake up call, whether that comes as a crisis or a disruptive innovation. It is obvious that Government regulation and oversight has done relatively little to reduce the “Wild West” behavior and mentality of the big players in our “industry”.

The first thing we need to do is scrap the concept of health insurance, because insurance is when something expensive but unusual and infrequent is paid from a pool of money that a lot more people pay into than withdraw from. In America today, everybody draws from that pool of money, even for things that are completely predictable, like having a baby or even an annual physical (except if you have Medicare, and then you get a Wellness Visit, but that’s another story). That means every single transaction of healthcare in this country becomes a profit center for one or more types of middleman, who most of the time adds little value but draws handsome revenue from what they do.

If we are trying to cover everybody for everything, let’s call it what it is, Socialized medicine. But are we ready, today, for a society where we all stop and consider the common good before we ask for that MRI, “just to know what’s going on”, or where drug prices are negotiated between a “single payer” like CMS or each State Health Department and the drug companies?
I believe the citizens of my adopted homeland prefer to have more freedom of choice than a Socialist system usually offers, and I believe that by having both the ability to choose and the responsibility to pay for services, we can make the healthcare value equation come out more even.

And, I’m sorry, but if we reign in the excesses of insurers and drug companies, American patients may act more responsibly, but as long as the gauging, fraud and abuse continue to be rampant in the industry, there will be no loyalty between patients and “the system”.

Then, our only hope will be a post-apocalyptic Direct Primary Caree model, which is just as American as the corporate model. Come to think of it, maybe even more so…

9 Responses to “The Illusion of “Other People’s Money””


  1. 1 Anonymous January 1, 2017 at 10:01 pm

    I do not understand your proposed solution. is your opinion that when I go to see you I will just pay your fee out of pocket and do so for hospital and tests? Do docs waive fees for the poor? Just curious!

    • 2 acountrydoctorwrites January 1, 2017 at 10:28 pm

      Your insurance pays me AND the executives and workers of their industry. My visit would be a lot cheaper without the $80,000/year per doctor we pay for everything related to insurance billing. Yes in the old days we gave free care to those who couldn’t pay.

      • 3 acountrydoctorwrites January 1, 2017 at 11:10 pm

        What we do in primary care is about like what you pay your mechanic. Imagine a bureaucracy that paid your mechanic bills for you with monies that ultimately came out of your paycheck…

  2. 4 Anonymous January 2, 2017 at 9:17 am

    ok, I understand what you are advocating — it just wasn’t clear to me. Sorry! It is an interesting concept. The best way to test such a plan would be to try it out in a few States. I don’t see it working, but you never know until you try.

  3. 5 J M Smith January 2, 2017 at 5:21 pm

    Perhaps I am off the mark in my comments, however… The concept of insurance implies people will pay small sums to potentially “recovery” costs of unexpected loss — but neither health nor wellness are objects separate from essential wellbeing and health-care does not imply a promise of recovery.

    If we agree to pool a portion of our individual incomes — cooperatively — towards assuring one-another’s essential health care needs might be met in times of individual crisis and if we are willing to accept responsibility for the outcomes of our personal choices–perhaps we might both mitigate costs and consequences of unanticipated misfortune and realize the benefits.

  4. 6 Sam January 3, 2017 at 3:22 pm

    As long as a profit motive exists in healthcare, there is no solution. You can constantly change the formula for how to slice the pie but someone is going to be shortchanged.

  5. 7 Laurence Bauer January 4, 2017 at 1:50 pm

    I enjoy reading your sharings. I was unclear re: the meaning of of your comment re: “a post-apocalyptic Direct Primary Care Model which is just as American as the corporate model. I see DPC as a way to reconnect patients and their Family Physicians in a way that directly aligns their relationship. It is, for most, also an affordable model. Both the docs and the patients are pleased with how it works. It removes the third parties. Is that how you see it or am I missing something. I can be reached at laurence.bauer@fmec.net. thanks

  6. 9 Vic Nicholls January 7, 2017 at 3:16 pm

    I love the next to last paragraph.


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