Americans Cutting Back on Health Care?

Well, how about that. It appears that privately insured Americans are using fewer medical services these days. Patient visits, drug prescriptions and procedures were down in the second quarter of 2010 compared to year-ago levels, reports the Wall Street Journal.

Weak demand could put downward pressure on spiraling health care costs and insurance premiums, the WSJ suggests. And what could be behind this remarkable change? Health economist Paul Ginsburg attributes some of the new behavior to the weak economy. But, he adds, “This could go beyond the recession. Being a less aggressive consumer of health care is here to stay.”

Perhaps this has something to do with it: More Americans are buying high-deductible health plans that make them bear a bigger share of the cost of their medical services. Eighteen million people have such plans compared to 13 million last year, according to the Journal. Believe it or not, people exercise more discretion and care as consumers when they have to pay for medical services themselves! Imagine that. They don’t go to the doctor as often — presumably cutting back on more frivolous trips — and they look for better deals when buying pharmaceuticals.

Most extraordinary! Who could have predicted it? Is there some body of thought that could explain why people consume more of a product or service when someone else is paying for it, and consume less when they pay for it thmselves? Could the field of economics shed some light on this perplexing question?

Finish reading this blog post on the Boomergeddon blog.


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36 responses to “Americans Cutting Back on Health Care?”

  1. Larry G Avatar

    The folks buying the high deductible plans are likely people who lost their gold-plated plans or people who cannot get a job that offers such plans or they have a pre-existing condition problem.

    This is also due to the steady ratcheting up of co-pays and caps for many employer-offered plans.

    I've always felt that this is one effective way to cost-contain any plan whether it's is private or government and that is to require a significant co-pay for typical discretionary therapies but pay in full – preventive care – and catastrophic.

    But you know what?

    When the govt does this – it's called "rationing" but when the Private Sector does it – it's called "high deductible".

    In order to put Medicare on a more sustainable track, it will have to be reconfigured to be similar to the "high deductible" plans.

    The big differences is that since the govt is the rescuer of last resort, they cannot contain costs by doing what the private sector does – by just dumping people…

    UNLESS – you and I are willing to see elderly people become homeless and dying at the entrances to the ERs.

    so you have to pick your poison.

    do you want the elderly to end up that way or do you want some kind of govt response to prevent it?

    My view is that we are wooses when it comes to this but we won't make the other hard choices either to make Medicare sustainable.

    People need to pay into Medicare from FICA from day one.

    Because we know – from experience – that if we don't force people to set aside money for their inevitable medical needs – they won't.

    And we have others who say that it is wrong/unfair/fascist to make young people who are healthy to do this.

    but when these healthy young people get old and sick – and broke – we blame Medicare for being the poster boy for ineffective govt.

    If you truly believe that none of the solutions involve the govt – then get ready to go broke when your own parents need 100K worth of medical care and the govt is not involved.

    and be prepared to see others elderly without sons & daughters willing to go broke – abandoned to the streets.

    What we need in my view – is just a tad bit honestly in the choices ….

    and I'm confident once we really do address the likely realities that most people are going to find a no-Medicare world as just simply unacceptable.

  2. Larry G Avatar

    The folks buying the high deductible plans are likely people who lost their gold-plated plans or people who cannot get a job that offers such plans or they have a pre-existing condition problem.

    This is also due to the steady ratcheting up of co-pays and caps for many employer-offered plans.

    I've always felt that this is one effective way to cost-contain any plan whether it's is private or government and that is to require a significant co-pay for typical discretionary therapies but pay in full – preventive care – and catastrophic.

    But you know what?

    When the govt does this – it's called "rationing" but when the Private Sector does it – it's called "high deductible".

    In order to put Medicare on a more sustainable track, it will have to be reconfigured to be similar to the "high deductible" plans.

    The big differences is that since the govt is the rescuer of last resort, they cannot contain costs by doing what the private sector does – by just dumping people…

    UNLESS – you and I are willing to see elderly people become homeless and dying at the entrances to the ERs.

    so you have to pick your poison.

    do you want the elderly to end up that way or do you want some kind of govt response to prevent it?

    My view is that we are wooses when it comes to this but we won't make the other hard choices either to make Medicare sustainable.

    People need to pay into Medicare from FICA from day one.

    Because we know – from experience – that if we don't force people to set aside money for their inevitable medical needs – they won't.

    And we have others who say that it is wrong/unfair/fascist to make young people who are healthy to do this.

    but when these healthy young people get old and sick – and broke – we blame Medicare for being the poster boy for ineffective govt.

    If you truly believe that none of the solutions involve the govt – then get ready to go broke when your own parents need 100K worth of medical care and the govt is not involved.

    and be prepared to see others elderly without sons & daughters willing to go broke – abandoned to the streets.

    What we need in my view – is just a tad bit honestly in the choices ….

    and I'm confident once we really do address the likely realities that most people are going to find a no-Medicare world as just simply unacceptable.

  3. James A. Bacon Avatar
    James A. Bacon

    Larry, there is a big difference between the government cutting back health care spending — rationing — and consumers cutting back spending. You see, when consumers make the cuts, they get to make the choice themselves. In the words of the economists, they get to optimize their own utility.

    When government makes the cuts, it maximizes its own utility — or that of the medical special interests working the system through lobbyists, PACs and television advertising.

  4. Larry G Avatar

    " You see, when consumers make the cuts, they get to make the choice themselves."

    Jim – with health care, that is simply not true.

    The high-deductible plan dictates what won't be paid for – just as the govt plans do.

    Tell me honestly, that your private insurance company doesn't decide for you what they will cover and not cover.

    When your insurance company says they will only cover 50% of the cost of some prescription drug that your doctor says you need, how is that any different that Medicare not covering it either?

    In both cases – what your coverage is – is not decided by you.

    Unless you want to compare no coverage compared to some limited coverage for high deductible.

    If the govt offered a high deductible Plan – would you then also complain that it's still a govt plan?

  5. “This could go beyond the recession. Being a less aggressive consumer of health care is here to stay.”

    ===============================

    Pipe Dream.

    When push comes to shove most people will be plenty aggressive.

    One thing about a recession is that no one wants to be sick for fear of losing their job, so they forego treatment,even preventive treatement, they might otherwise have had.

  6. "When government makes the cuts, it maximizes its own utility — "

    It is not either or, or does not have to be.

    You can still buy your own service if you think it is worth while, after your government service runs out or is refused.

  7. The first wave of baby boomers are retireing, and losing their health insurance in the process. They probably maximize dental and preventive care while approaching retirement.

    While they remain healthy they will tend to do without, temporarily lowering health care demand from exactly those you would expect to need it the most.

  8. Larry G Avatar

    the way we "do" health care actually harms government and private industry – large and small.

    For fear of not having coverage, we have many folks who take "safe" (often govt) jobs as a conservative safe haven rather than work entrepreneurially by themselves or with others in small business start ups.

    The number one reason why unions have such a stranglehold and won't give it up is – health care for their members.

    Big companies are seriously hamstrung competitively against European/Japanese counterparts by the costs of their retirees medical care and are encouraged to dump people before they retire with benefits.

    This is why 40-60 years olds cannot get hired and why many companies don't hire full-time positions that have benefits any more…

    but I have a question for Jim.

    Why can't an employee take the money instead of the employer-offered plan and act in their own best interests?

    And why are health care plans not taxed as income?

  9. And why are health care plans not taxed as income?

    ==================================

    Why would I get taxed on benefits or services I don't necessarily get? My company pays part of my health insurance premium, but the monies are distributive: I may not use the health care benefits and therefore the money paid on my behalf is actually used by others, but I pay the taxes on it.

    Unlike gasoline, we woul like health isnurance to be cheaper, and more widely used, not less. If you want less of something, just tax it.

  10. Larry G Avatar

    you're not getting health care as benefits. You're getting insurance the same way the company might offer you insurance on your health or car.

    The cost of the insurance is a compensation that ought to be taxed like any other.

    And if it was, and you could take the money instead of the insurance – it might benefit you better …for instance, your spouse get's a family plan that covers you and you get to use the money for other things.

  11. Larry G Avatar

    " Opposition to the landmark health care overhaul declined over the past month, to 35 percent from 41 percent, according to the latest results of a tracking poll, reported Thursday.

    Fifty percent of the public held a favorable view of the law, up slightly from 48 percent a month ago, while 14 percent expressed no opinion about the measure, according to the poll by the Kaiser Family "

    http://www.washingtonpost.com/wp-dyn/content/article/2010/07/29/AR2010072900004.html?nav=hcmodule

    Looks like Obama's ace in the hole on Obama_Care is more and more people losing their jobs and their insurance, eh?

    Even the hard-core anti-Obama folks might have a change of heart if they get dumped and lose their insurance.

  12. "The cost of the insurance is a compensation that ought to be taxed like any other."

    ================================

    Why would you tax it like any other compensation? It is not the same kind of compensation.

    If that is the reasoning, why not tax booze, cigarettes, and luxuries same as any other purchase?

  13. "And if it was, and you could take the money instead of the insurance – "

    Now you are adding an additional qualification into the argument.

    You can opt not to participate and keep your share of the payments, but you usually don;t get to keep the employers contribution, too. Thats one of the things that makes insurance different and why we don't tax it: you might not get it.

  14. Larry G Avatar

    because they are not compensation for work.

    The law allows you to defer taxes on your pension…

    and the law allows HSAs

    why not allow employees who don't want the health plan to have the money go into an HSA so they can use it to cover expenses not covered by a spouse health plan or even a high-deduction plan?

    What I am saying here – make no mistake – is that our current laws have screwed up health care and turned it into an anti-market, anti-competitive mess.

    If the law changed to tax health care plans – on what grounds would people object to that?

    We have government laws here that legitimizes winners and losers and haves and have nots for no explainable reason.

    If we gave the money to every employee and required that it was only tax free if it was spent on health but let employees choose on how to spend it – we'd have competition in the market.

    but neither the Republicans nor the anti-Obama-care have ever mentioned that as an alternative to Obama_care.

  15. Larry is right about how we do health care.

    I don;t understand why the Republicans haven't figured out that HCR could be the best thing to happen to small businesses.

    Unless they only like big business.

  16. "why not allow employees who don't want the health plan to have the money "

    =============================

    Because, as you say it is not compensation forwork. It is not their money, it is the companies money, and the company might prefer to use it to keep employee contributions down for everyone else.

    There is nothing to prevent a company from setting up a plan as you describe, why do we need a law to REQUIRE it?

  17. "why not allow employees who don't want the health plan to have the money "

    =============================

    Because, as you say it is not compensation forwork. It is not their money, it is the companies money, and the company might prefer to use it to keep employee contributions down for everyone else.

    There is nothing to prevent a company from setting up a plan as you describe, why do we need a law to REQUIRE it?

  18. "…if they get dumped and lose their insurance."

    Been there done that.

    What people need to understand is that it is more a matter of WHEN, not if.

  19. Larry G Avatar

    " Because, as you say it is not compensation forwork."

    If I said that I misspoke.

    I said that it WAS compensation for work.

    And most companies offer the same HC to all employees – for instance schools do.

    But if the school teacher already is on the spouses plan, their school plan automatically becomes secondary insurance and only picks up what the primary pays – and between the spouse and the teacher, they essentially pay twice as much in premiums for not twice as much in coverage.

    If they got the money instead, they could likely buy a much less expensive gap coverage plan and use the savings for other things.

    The current Health Care system is a convoluted mess basically owned and operated by big business who did their best through their Republican supporters to turn ObamaCare into a CF – and did succeed.

  20. It was a CF before and it will probably be a CF now, but at least it will be the same CF in every state.

    And it isn't just health insurance, did you see the scam on life insurance?

    As for inexpensive gap policies, you probably don't get what you pay for. Like those temporary or interim policies for between jobs: they open you up to prexisting condition problems so they cost more than they save.

    If the employer wants to offer a cafe plan, he probably can, and the insurors probably don't make it easy: they would rather offer bundled plans.

    But I'm opposed to paying income tax for stuff that isn't strictly income: if you go that route, people wo get free transit will wind up paying tax on that "money" in which case they will probably decide they would rather have the money and drive.

    We use the tax free status to encourage certain activity.

  21. Anonymous Avatar
    Anonymous

    Two thoughts:

    Larry G. and hydra RH need to get their own Blog.

    Mr. Bacon needs to revise his Boomergeddon Blog. It has ugly grapic.

    blog advisor

  22. Larry G Avatar

    " We use the tax free status to encourage certain activity."

    we do but the result is a stark dividing line between haves and have nots and people, acting in their own and family self interests do harm to a true competitive market economy as well as, ultimately harm to their own interests also.

    people subvert their own ethics to hold onto a job that provides health care when if they were not held hostage would tell the crooked employer where to go and walk away.

    People who are creative an perhaps destined for greater things have to play it safe and stay at a stifling job that they would not otherwise.

    Our basic American entrepreneurship has been crippled by the quest to make sure you and your family have health care – and to prophylactically protect themselves from almost certain bankruptcy if their kid has a heart defect or similar.

    getting that health care is the holy grail for most families in modern society.

    the only problem is – more and more good, hard working, well-educated, motivated people are essentially denied the ability to work hard and prosper.

  23. Larry, I agree.

    I think health insurance should be divorced from the fact of employement. At the same time, group plans offer lower costs. If eveyone had to buy individual insurance the individuals would be at a disadvantage compared to eht insurnace comapnies and they would pay much higher costs.

    Employers provide health plans as an incentive to work for them. They have to, in order to compete with other businesses. But, if health insurance was privatized,there is no guarantee that employers would cough up an equivalent amount of cash in the paycheck instead.

    In the present circumstance you have large employers competing with each other (and against small employers) for workers. With privatized (non-employer provided) health insurance it is you against the insurance compapny.

    If I could buy insurance on the free market, I would consider having my own full time business. I'm sure many others are in a similar state.

    Eventually, under Obamacare, I will be able to buy my own private insurance, because the insurance company will no longer be allowed to turn me down.

    It remains to be seen what price they will charge me, but it will probably still be much cheaper to get insurance through an employers group plan.

    If that happens, I'm getting isurance that I maight have to pay $10,000 privately, but between uys, my employer and I are paying only $8,000 because of the group plan.

    Do I get taxed on my employers contribution ($6,000) or the market value of the insurance, which is $10,000?

    I get taxed on the maret value of my home, even though i never sold it, now I'm going to get taxed on the market value of my insurance, even though I never bought it?

    Big employers probably work a bettter deal with their insurors than small ones. Someone working for a small company would pay more taxes for the same insurance just bvecause it costs their small company more to buy?

    All of my mployers have provided health care assistance. health insurance was a consideration when keeping or changing jobs, but I never considered any of the companies i worked for as crooked. (Except one, and I wasn't there long.) (Also, I never worked for an insurance company, which I believe ARE crooks.)

    ================================

    If Larry and I get our own blog, there is going to be a lot of empty space around here. I'm sure the conversation would be interesting. Blog advisor is welcome to chime in if he has any thoughts. Same for any other lurkers.

  24. Larry G Avatar

    In all honestly folks, how many 1000+ page bills pass Congress every year and how many people actually read them?

    how many bills did people read and understand the ramifications and unintended consequences BEFORE Obama-care?

    how many people got upset when Medicare Part D was passed in the wee hours of the morning with Tom Delay threatening his fellow Republicans with retribution if they did not come around?

    I ask these questions because if the only bill you ever really did read – and understand ..and were expecting the downstream expected and unexpected consequences was Obama-care

    what does that say about you in terms of your claims that this particular bill was unique and particularly egregious compared to prior legislation?

    Was the "death panels" that got your interest?

    or the " we'd put granny down" fears?

    Obama-Care is no more or no less complexity than Medicare.. no more unintended consequences of that legislation which has had to be changed several times to deal with things not anticipated.

    I would assert to people today that if it was Medicare that we were talking about – the same people shouting the same concerns would be in place.

    and yet now – today – many of the same folks so "worried" about Obama-Care will quite adamantly tell us that Medicare (which is Obama-care for those 65 and older) cannot go away.

    I just question what appears to be a pretty serious double standard between Obama_care legislation and all the other legislation that has been passed.

    Does anyone know how many pages the Patriot Act or Medicare Part D is?

    Did you read that legislation?

    Did you understand it?

    Did you anticipate the unintended consequences of those laws?

    If you did not.. then I would ask why start now?

    what's the difference?

  25. Larry G Avatar

    I probably came across a bit harsh on the last post.

    Before we ever knew a person name Obama even existed, we were being told that health care in this country was in trouble.

    Hillary Clinton attempted to do something – was roundly defeated and told that the way she went about it was wrong and that the next 8 years we would get shown how it should have been done.

    Nothing Happened.

    We had another Presidential election and both candidates said that fixing health care was at the top of their lists of things that had to be done.

    The nation picked the younger guy – the more inexperienced guy – the guy who had the arrogance to suggest that we needed a single-payer system like Medicare – like most of the rest of the industrialized world has.

    Throughout this whole period, I never saw a cogent alternative plan offered by those who opposed this approach – not when they opposed Clinton, not in the next 8 years and not when this guy became President.

    Instead they did what they could to destroy it and what emerged is what survived.

    and now.. the same vultures are pointing out the "defects" … as if they did not have anything to do with any of it and just stumbled into the game.

    I, for one, would have been open to other proposals… including those that would have been politically clever enough to make it very hard later on to convert it to anything that resembled universal care…

    as long as something was passed even if it had to go over the Democrats heads.

    Nothing was done.

    myriad attempts were made do destroy what the Dems proposed and when it had been sliced and diced into a CF …

    those who opposed it from the get go.. now complain about it's "flaws" ( of which I admit there are many).

    but I have lost patience with those who won't execute.

    Either do what you say needs to be done – or be prepared to get something else.

    I see the folks who were opposed from the get go – as the reason why we have what we have right now.

    Had they even lifted one finger to try to put together SOMETHING, chances are we would never have gotten to this point.

    Each of us has to ask ourselves – "where were you on this issue way back when?"

    for myself, "way back when", I agree with those that said we had a big problem that was going to get bigger …

    .. and I was all for.. whatever Clinton would get done… or the Republicans in the next 8 years, or this administration…

    I was NEVER OPPOSED to getting it fixed and I was ALWAYS IN FAVOR in getting something done.

    How many who now oppose Obama_care can say that?

    Remember.. more than 50% support Obamacare.. right now.. and I'll wager that more than a few.. believed all along that something should be done and now that it has been done.. it's a long way from ideal and may actually be quite stinky… but changed happened, as promised, as if it's not what we want, I feel quite confident, that, just like Medicare, it will get changed.

    but that's looking forward – not backward.

    and looking backward is what the critics are doing right now….

    in my view..

    they never had a forward agenda to start with …in my view.

  26. Mr. Bacon,
    Do you realize you are doing a research faux-pa? Stringing together disparate datasets and then making assumptions about those datasets?
    (formerly Mimi Stratton, now using my real name/pic)

  27. James A. Bacon Avatar
    James A. Bacon

    Hi, Moira,

    I'm glad to see you using your real name and identity. I hope others follow your example.

    I'm not sure what you mean about "stringing together disparate data sets." Could you be a little clearer about what kind of methodological faux pas was committed?

  28. Anonymous Avatar
    Anonymous

    Larry, where did you get the poll information that indicated 50% of Americans approve of "Obamacare"? I loosely follow polls on Real Clear Politics because it caputures a variety of polls.

    On 8/4/10, RCP indicates an average of 37.0% favor HCR as passed by Congress and signed by the President, while an average of51.8% oppose it. http://www.realclearpolitics.com/epolls/other/obama_and_democrats_health_care_plan-1130.html

    The Missouri vote indicates much stronger opposition. While still arguing HCR has benefits for the public,"I certainly noticed the vote on Prop C, the healthcare law, and message received," Sen. Claire McCaskill (D-Missouri) said. http://www.realclearpolitics.com/video/2010/08/04/sen_mccaskill_message_received_on_missouri_voters_against_health_care.html

    TMT

  29. Larry G Avatar

    here is TMT – I'm pretty sure I provided the same link when I made the claim.

    http://www.washingtonpost.com/wp-dyn/content/article/2010/07/29/AR2010072900004.html?hpid=topnews

    "…. Among Republicans, opposition to the law remained steady at 69 percent.."

    "…Independents, who can tip the balance in elections, split 48 percent to 37 percent …"

    I'm sure the mileage varies on the different organizations that are polling….

    I think one reason the polls are trending this way is more and more folks have lost their jobs and their insurance and are desperate for some kind of coverage and they see nothing from the Republicans on what they'd replace ObamaCare with – just as they had no answers in the previous 8 years.

    The Republicans have no plan.

    All they have is opposition to this.

    The folks who support the Republicans are folks who have insurance – not the ones who don't.

    would we agree on that?

  30. What I find objectionable is the leap to conclusion that doctor visits are down because more people are buying hi-deductible plans. We have a quote from Wellpoint's CFO and an economist studying h/c companies saying demand is down. We have Paul Mango saying hi-deductible plans are being purchased in greater quantity, no study cited. Those are the two disparate datasets I refer to, although there isn't even any data or study cited, just the leap to conclusion it's because people don't want to spend their own money to pay for visits. Was there a survey conducted of those people who purchased hi-deductible plans asking if that influenced them to go to the doctor less? No, it's supposition. This is extremely poor journalism on the part of WSJ.

  31. James A. Bacon Avatar
    James A. Bacon

    Moira, I half agree with you. It is wrong to imply, on the basis of the limited information presented in the WSJ article, that high-deductible plans fully account for the decline in health care utilization. But *something* has to account for that decline, and high-deductible plans are one plausible reason.

    Another plausible reason is that a lot of people lost their health care coverage during the recession. The WSJ didn't present the numbers for that, so we don't know how big a factor it is.

    Regardless, I feel confident that the surge in the number of Americans covered by high-deductible plans is a contributing factor. The number of enrollments is significant, and the incentives for conserving on health care utilization are powerful.

  32. Larry G Avatar

    both my wife's dentist and mine have seen significant drop-offs in just about any discretionary work.. including teeth cleaning and even cavities…

    same deal with our doctors.

    two years ago, it was a month before we could get it.

    Now? how about tomorrow or this afternoon if you call in the morning?

    Anyone else noticed this?

    when the economy craters and folks lose their insurance in droves and WSJ is blathering on about some cockamamie idea about high deductible policies, one has to wonder exactly what they are doing because it borders on misrepresentation – at the time when misrepresentation seems to be the strategy de jure in politics these days.

    Should it really surprise anyone that most discretionary purchases are probably down in a recession?

  33. *Something* has to account for the decline . . . You *feel* confident . . . what is that confidence based on? Do you have data to show that the same people who are not going to the doctor as much are those who have purchased hi-deductible health plans? I found no correlation in the article or in your blog. There could be many reasons for fewer doctor visits, and it should be studied further. But jumping to conclusions based on *feelings* and perhaps bias is not helpful to our understanding.
    We need to be much more discerning in our expectations of journalism, in the blogs we read, and in court testimony we accept as *fact*, particularly when wholesale societal changes are the result. Last night we got a clear picture as Prop 8 CA ban was lifted and the ruling was made available (http://www.scribd.com/doc/35374462/Prop-8-Ruling-FINAL) that the so-called facts used in the case about children not nurtured properly in same-sex marriages, for instance, was due largely to the testimony of one person, David Blankenhorn. The other witness offered backed up Blankenhorn's evidence by saying he read Blankenhorn on the Internet, and therefore he believed it. Those two witnesses were the only *experts* offered. They weren't experts. They had no business offering testimony at all.
    You present this blog in a certain manner; that it is serious, that the issues presented are based on journalistic best practices. That was my expectation, at any rate.

  34. James A. Bacon Avatar
    James A. Bacon

    Moira, I'm still not sure what all the fuss is about.

    Let me refresh you with what I said: "Perhaps this has something to do with it: More Americans are buying high-deductible health plans."

    *Perhaps* this has *something* to do with it.

    That hardly implies that high-deductible policies accounted for the full decline in health care utilization. Indeed, in the preceding paragraph, I quoted health economist Paul Ginsberg as attributing the decline to a weak economy.

    The larger point, which you seem to be overlooking, is this: “This could go beyond the recession. Being a less aggressive consumer of health care is here to stay."

    I totally agree with that. The rise of high-deductible health plans supports that proposition. As employers shift more cost of health care to their employers, what else would you expect? For people to spend more?

    What exactly do you disagree with?

  35. The premise of your post is that if people paid more of their health services, they wouldn't go to the doctor so much. You draw a conclusion that this is happening based on a poorly-researched WSJ article, and you claim that market forces will solve the high cost of healthcare.

    Yes, healthcare has skyrocketed, at the same time that access to healthcare has gone down. For very complex cardiac, rescue care, or advanced chemo treatment for cancer, America has a great healthcare system. But for chronic disease, access to physicians is not good. We don't value primary care in this country, because it doesn't pay as well. And the fee schedule for services is often structured in ways that do not support preventive care.

    We often pay more for services that might lengthen the patient's life by 5 months, as opposed to controlling diabetes for 30 years with exercise/diet/meds. And yet the technically very skilled procedure is much more expensive because it's charged entirely in terms of the work on the part of the doctor rather than the benefit to the patient. And the hospitals want the doctors to use the expensive technology because that's how they make profit. Market forces? Market forces are the reason healthcare is so screwed up.

    We don't value primary care doctors, generalists, family doctors highly at all. The compensation is relatively low and that's why we have fewer and fewer of them.

    The issue is much, much more complex than you paint and healthcare costs are not rising because people go to the doctor too much.

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