The Economist blog featured a very well-written expose yesterday on "Economism" and the way in which framing the debate over how we pay for health services really IS the debate over how we pay for health services. I won't try to rehash the blogger's argument here; he's smarter than me and actually gets paid to put words together into sentences. I do want to add, however, that from my personal experience paying directly for health services DOES influence the health services one consumes, for better and for worse.
This issue is forefront in my mind these days because I recently finished paying off the service fees for our upcoming homebirth, all $3000 of them, only to find myself having to shell out another $150 or so for sterile medical supplies to have ready for the day of. And let me tell you, even though I had the option of pushing a single button and buying the homebirth pack online, I shopped around for every stupid item on that stupid list. No way was I going to pay $.20 each for several individually wrapped bendy straws when I have a pack of bendy straws in my kitchen cabinet. I've been through this once before; I know they're not for the baby. Neither did I buy ten individually wrapped gauze pads when a pack of 20 was less expensive. Or an umbilical cord clamp. Fuggin, just use a shoelace!
No, just kidding - I bought the cord clamp. Please, no one actually use a shoe lace; it can cause major bleeding.
Also, when you're paying for everything out of pocket you're more likely to push back against your provider's recommendations. Homebirth midwives tend to be an earthy crunch bunch, and no harm there, but I take it with several grains of sea salt when they instruct me to stock homeopathic arnica for swelling, when I already own tylenol in convenient medically effective quantities. We can have a separate discussion on whether homeopathy is even a real thing, but not on my credit card. Also, I'm not buying organic olive oil to use as a lubricant. If regular olive oil is good enough for cooking in my kitchen, it's good enough to rub on my taint.
All this is to say that when offered an a-la-carte menu, as I was when filling my birth supply list, the price of things affected my choice of treatment to some extent. This may be good in the sense that a smart consumer drives medical costs down. But this is only true up to a very small point. If I was out to save money on this endeavor, after all, the easiest thing to do would have been to give birth in a hospital where the whole kit and caboodle would have been free. I didn't choose that option because my preference for homebirth over hospital birth is price inelastic. So the fixed cost part of the birth, the 3 grand to pay the midwives, did not get any haggled. And how could a patient even begin that conversation? Look, I want you to give me good attentive care and save the life of my baby in dire circumstances, but could you think about doing it at a 20% discount? Because my husband is a member of the Massachusetts Teacher's Union?
Anyway, it's a very interesting discussion from an economist's point of view, if you can keep from getting mad over the disparity of maternity care state by state. And at least for me it's all done and paid for as of today! Now just to pop out that kid some time in the next month and hope it doesn't need much in the way of new clothes...