Friday, July 21, 2006
Goodman on HSA detractors, Part II
["CostRx: HSAs: A 'paternalistic device,'" United Press International, 20 July 2006.]
In the second half of UPI's interview with NCPA President John Goodman, he takes on standard union arguments against HSAs:
Q. Unions, particular the United Food and Commercial Workers, have not warmed up to the idea of the HSA. Jill Cashen, head of UFCW, recently said, "Expecting hourly wage workers to have to make good choices about healthcare is dangerous. People are going to choose not to get treatment because they don't think they need it or because they simply can't afford it" Any comment?
A. That's exactly the attitude of a person who thinks the average citizen cannot make good decisions about the important things in their lives, and (who) wants government or some bureaucracy to regulate where all their money goes. There's no evidence that people don't make good decisions. Of course, there will be cases when they don't, but on average, people tend to be self-interested and when they manage their own healthcare dollars, they manage to do a pretty good job of it.
Q. In criticizing HSAs, Cashen also said, "Putting the burden on the individual to make choices based on finance rather than real need is a losing proposition." How would you respond?
A. I don't think she understands healthcare. We just went through the whole problem with arthritic pain drugs (like) Vioxx and Bextra. It turns out that most people who were taking Vioxx shouldn't have, and the best predictor (of whether a patient would choose Vioxx) was if an insurance company was paying the bill. Well, what's the alternative to these prescription drugs, which not only are costly, by the way, but have these risky side effects?
The alternative is ibuprofen. Vioxx (had) cost about $800 a year more than ibuprofen for the arthritis patient. Drugs affect different people differently. How can any one of us make a decision for somebody else about whether the extra cost and risk is worth $800 a year? They can't. Those are exactly the decisions that people need to make on their own, and they need to be able to (benefit financially) when they make decisions that save money.
Q. You don't think a person might forgo needed treatment because the money has to come out of a limited savings account?
A. What are you calling "needed" treatment? How do I know that the person "needs" Vioxx or "needs" ibuprofen? Only that person can say how much relief he or she gets from the different pills and that has to be weighed against the money.
Q. But what if a person doesn't go to the emergency room when he or she needs to because there's not a health plan backing them up?
A. What we want is for the money to be there, so no one should not go to the emergency room because they can't pay the bill. But they should understand that (the emergency room) is an expensive way to get healthcare, so if they're going spend a thousand dollars in the emergency room, then they need to understand it ought to really be worth a thousand dollars. If it's something that can be put off until the next day, and for a tenth of that cost (at) the local clinic, then they shouldn't be in the emergency room.
We have all these studies that show that half of the people in the emergency room should never have been there in the first place. And half the people in a typical doctor's office don't need to be there. And there's no way we're going to solve these problems unless individual patients start managing their own money and start thinking about the alternatives.
[Gregory L. Schneider, "Competition and physician-patient relationship," The Kansas City Kansan, 14 June 2006.]
In the second half of UPI's interview with NCPA President John Goodman, he takes on standard union arguments against HSAs:
Q. Unions, particular the United Food and Commercial Workers, have not warmed up to the idea of the HSA. Jill Cashen, head of UFCW, recently said, "Expecting hourly wage workers to have to make good choices about healthcare is dangerous. People are going to choose not to get treatment because they don't think they need it or because they simply can't afford it" Any comment?
A. That's exactly the attitude of a person who thinks the average citizen cannot make good decisions about the important things in their lives, and (who) wants government or some bureaucracy to regulate where all their money goes. There's no evidence that people don't make good decisions. Of course, there will be cases when they don't, but on average, people tend to be self-interested and when they manage their own healthcare dollars, they manage to do a pretty good job of it.
Q. In criticizing HSAs, Cashen also said, "Putting the burden on the individual to make choices based on finance rather than real need is a losing proposition." How would you respond?
A. I don't think she understands healthcare. We just went through the whole problem with arthritic pain drugs (like) Vioxx and Bextra. It turns out that most people who were taking Vioxx shouldn't have, and the best predictor (of whether a patient would choose Vioxx) was if an insurance company was paying the bill. Well, what's the alternative to these prescription drugs, which not only are costly, by the way, but have these risky side effects?
The alternative is ibuprofen. Vioxx (had) cost about $800 a year more than ibuprofen for the arthritis patient. Drugs affect different people differently. How can any one of us make a decision for somebody else about whether the extra cost and risk is worth $800 a year? They can't. Those are exactly the decisions that people need to make on their own, and they need to be able to (benefit financially) when they make decisions that save money.
Q. You don't think a person might forgo needed treatment because the money has to come out of a limited savings account?
A. What are you calling "needed" treatment? How do I know that the person "needs" Vioxx or "needs" ibuprofen? Only that person can say how much relief he or she gets from the different pills and that has to be weighed against the money.
Q. But what if a person doesn't go to the emergency room when he or she needs to because there's not a health plan backing them up?
A. What we want is for the money to be there, so no one should not go to the emergency room because they can't pay the bill. But they should understand that (the emergency room) is an expensive way to get healthcare, so if they're going spend a thousand dollars in the emergency room, then they need to understand it ought to really be worth a thousand dollars. If it's something that can be put off until the next day, and for a tenth of that cost (at) the local clinic, then they shouldn't be in the emergency room.
We have all these studies that show that half of the people in the emergency room should never have been there in the first place. And half the people in a typical doctor's office don't need to be there. And there's no way we're going to solve these problems unless individual patients start managing their own money and start thinking about the alternatives.
[Gregory L. Schneider, "Competition and physician-patient relationship," The Kansas City Kansan, 14 June 2006.]
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