Stupid People and Health Care

Ezra Klein compares his views on Medicare to those of a conservative and finds that, while they have similar views on the problem, they differ greatly on the solutions:

What always fascinates when I read right-wing critiques of American health care is how similar our diagnoses are, but how diametrically opposed our treatments would be. For the right, more consumer risk is required in order to encourage wise treatment decisions on behalf of patients. That means, of course, that those who make poor decisions, or simply get really ill, face financial ruin. That seems crazed and cruel to me. While I do think the left needs to take financial incentives more seriously than it does, I’d favor having many more carrots than sticks, and I’d want to separate out poor decisions and behaviors from simple bad luck. HSAs and all the rest punish the illogically stricken as surely — or more surely — than they do the stupid. And I’m not even ready to punish the stupid. So much as I think it inadvisable that half of those with HSAs haven’t deposited a cent, I’ve no interest in abandoning them to the consequences of that oversight.

Ezra has it right, but to that I would add that, when it comes to health care, there are a lot of “stupid” people. Stupid is really the wrong word here because I’m speaking of the attitudes of most people, regardless of intelligence. The average person (and even some of my collegues, but that’s a topic for another day) lack sufficient knowledge to make decisions with regards to chronic and preventative care.

Most people might know to go to see a doctor if they are seriously ill (assuming they aren’t among the growing number who cannot afford it). Far fewer understand the importance of treating problems like elevations in blood pressure, blood sugar, or cholesterol when they have no symptoms. It is far more economical, both for the patient and society, to treat hypertension and diabetes early and aggressively than it is to pay for coronary artery bypass surgery, amputations of limbs, renal dialysis, and long term care following a stroke.

We cannot force people to make wise decisions, but at least we can make the system one which encourages patients to do the right thing. Health savings accounts, accompanied by high deductible insurance policies, lead to people putting off routine and preventative care. Patients are much more likely to seek needed medical care when it does not come out of their own pockets, but do not like to spend either thier own money or money in their HSA. There are many possible ways to make health care more affordable, but in the long run HSA’s are a poor method.

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  1. 1
    kj says:

    Well, who among us is without health insurance?
    *KJ raises her hand*

    However, I’ve been fortunate with the doctors I’ve met over the years. The one we have currently has been our primary care doc for the last five years… we drove a 6 hour round trip to see him at least twice a year when we had health insurance, just because he’s so good, and fortunately for us, we don’t have to deal with that drive anymore to see him.

    And we still see him. He wrote off the cost of our last physicals out of the goodness of his own heart. He’s well aware we are paying out of pocket for everything and does what he can to help, for example, by giving us samples for some of our meds.

    We are extremely lucky to have such a doctor and such an open, honest relationship with him, and we know it.

    Bottom line, it’s up to us to pay for our care, or to not pay, and not care. We care. And omg, do meds cost a lot! I paid no attention to the cost when I had insurance. None at all.

  2. 2
    kj says:

    I also realize that there are many people who have not had the fortunate luck with doctors that I have had, and have no idea how important is basic maintance care of the body. These people may also not have been taught how valuable physical care is. We’re not all that far removed from generations of people who didn’t want to ever go to the doc, because “If you go, they’ll put you in the hospital, and that’s where people go to die.”

    My father, born at home on the farm, wasn’t a big fan of doctors. However, he understood the service they provided and drilled in us that going to a doc regularly was just like taking the car into the shop. You wanted your car to “run like a sewing machine,” well, you wanted your body to as well.

    I’ve been lucky.

  3. 3
    Jeff Brailey says:

    If an interventional cardiologist told me I needed a CABG,, I wouldn’t be looking for a surgeon, I’d seek out a second opinion from a good noninvasive heart doc.

    In April 2004, I was told I was a walking time bomb and needed a quintuple bypass. I sought a second opinion, started on medication and am still ticking. Now was my time bomb a dud, or was the interventional cardiologist one? Check out my blog at

  4. 4
    Ron Chusid says:


    Without specifics such as cath results and info on your symptoms I wouldn’t attempt to judge the advice for the CABG was good advice. I’m glad that you are still ticking, but this in itself isn’t proof that a CAGB was bad advice. A CABG is recommended not wtih 100% knowledge that a person will die but that the person is at a high risk. Take a group of 100 with similar findings and some will do ok and some will not. One question is how much of a gamble they are willing to take. We also look at a longer time frame than this. Having survived since April 2004 does not mean you are necessarily out of the woods but hopefully measures such as lowering of LDL have resulted in some regression of your heart disease. In additon, surgery often makes more sense in people who have chest pain which does not respond to medical therapy.

    Seeking a second opinion was a good idea as there certainly are people who will do well without surgery, and surgery is not without complications either.

    While I cannot say whether a CABG made sense in your case, with regards to the original post I assume we can agree that early preventative treatment for heart disease is preferable to waiting until a point when a CABG is under consideration.

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