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Medical bureaucracy

Yesterday I blagged about a biased book reviewer who was skeptical about patients’ ability to make rational decisions and look out for their own well-being, and not the least bit skeptical about the ability of a socialist State to make decisions for people and improve economic efficiency.

I had another thought I wanted to flesh out briefly: This Statist and millions (billions?) like her think many medical decisions are too difficult and complex for patients to make, and allowing that to happen would result in bad medical decisions, frustration, confusion, wasted time, and wasted money. They would, as Anthony de Jasay would say, replace this private problem with a State problem so that agents of the State would handle many or most of their medicine-related decisions, easing their minds, saving their time and money, and improving their health. These health-care decisions could include things like which types of prescription drug plans are available, which doctors should be in your “network,” which conditions/events should be covered by insurance, etc.

What they don’t mention is that the bureaucratic hell of dealing with the State and with the State-created and State-protected insurance companies replaces the difficulties and complexities of dealing with the medical issues. We don’t have private problems fixed by the State and replaced with nothing, or at least with nothing nearly so egregious. The State problems that replace the private problems are, according to what I’ve read, heard, and experienced, worse or, at best, no better than private problems, and the State interventions lead to more problems that induce calls for more State interventions. That is always how State intervention in private decision-making goes. In chapter 2 of The State, Anthony de Jasay talks about this private problem vs. State problem dichotomy in the context of legal issues and legal protection and recourse. But I think, and he would certainly agree, that the legal principle he was talking about extends to all areas of life the State encroaches upon in addition to the laws and the courts.

When you think about it, doesn’t it seem like something is wrong when so much paperwork and identification is involved in your health care? Your employer sends you mail about the new health insurance plan you’ve been put under, and the ratio of bureaucracy to your own personal choice in the matter is astounding. You make a doctor’s appointment, and the first thing they ask you about is your insurance card number and the health plan you’re under. You go to a doctor’s office, and they have the utmost concern for your insurance card or papers, like a government office. Most doctors can’t devote enough time or thought to one patient because they have so many because the cost to the patient is relatively small, so demand is high (yeah, quantity demanded, I remember my 12th-grade economics). In my health care plan, you are not allowed to make an appointment with a specialist until you’ve seen your primary-care physician and gotten their permission to make an appointment with the specialist. The last time I went to a specialist, he told me, after his very short visit (his resident saw me for most of the time, but he was in too much of a hurry, as usual), that he hopes all goes well and that if I need to make another appointment with them, I’d have to go through my primary-care physician first. Just the fact that he would feel need to mention that in the doctor’s office reveals how overburdened and constrained the medical-care field is by the bureaucracy and State restrictions. Such as on the supply of doctors and the price of doctor appointments. It also shows how completely the bureaucratic mentality permeates all of medicine, which everyone must agree just feels wrong.