Financial considerations are always part of the health care equation and they should be! Would I be better off having a check-up every month instead of every year? What are the cost and benefit considerations for me? Doctors need to collaborate with and educate patients about both the reasons for their care recommendations — and also the costs of care. There are what — 90 some diagnostic tests that can be done on my blood sample. Why shouldn’t I have all 90 done every time I go to the doctor? To keep my health care insurance premiums under control and also optimize my health, should I as a patient have or buy insurance that pays for 100 percent of everything I think I might need? Or, even everything my doctor thinks I need? Well, I and my doctor should make that decision — unless I am unable to do so.
My point: Irrespective of the degree of freedom in the health care system, there will always be rationing by cost and affordability, and this is as it should be. The key question is: who decides what will be rationed — I and my doctor or someone else? When I ration my own health care (with my doctor’s recommendations), finances are for me a big part of the equation. Otherwise, without me considering costs there is no “rationing mechanism,” and consequently no consistent way to reliably allocate medical resources tailored to my individual needs as a patient. Finally, we should provide money to allow patients to make informed choices in the medical assistance and Medicare programs too. We all need skin in the game. Doctors appreciate our active participation in our care.