NEJM Roundtable: The Cost of Health Care, Part II: The Public Option
By Barbara Lock, MDDecember 03, 2009
Surgeon and writer Atul Gawande hosts a New England Journal of Medicine Round Table about health care costs, including the concepts of a public option, a single payer system, and what we want to spend our health care dollars on. Gawande does bring up the concept of patients having "skin in the game", or medical savings account. A guest says that patients who pay for care themselves tend to make bad medical decisions and would need catastrophic health care coverage. I believe that there is no reason that this model could not be tweaked to provide catastrophic and basic coverage for everyone while incentivizing health care savings chosen by patients. Every patient has different medical hopes, fears, and value systems. Having "skin in the game" helps empower patients to guide their own medical decision making.
Another guest says quite condescendingly "There's no one who thinks seriously about this who thinks that thinks a consumer based approach can control costs in a fundamental way. Ultimately, the supply side is where this has to happen, physicians make the decisions, hospitals make the decisions....", but then he says quite correctly "unless you give people a financial stake in what's happening, there is going to be a backlash against the accountable care organizations." Having people pay out of pocket and retaining health savings IS their financial stake.
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