Last week, we went to Outback Steakhouse for supper. The meal was excellent, and the service superb. I paid the bill and we went on our way. Naturally, a week later I received a bill from the cook for preparing the food, and a separate bill from U.S. Food for supplying the deceased cattle to the restaurant. And, of course, a bill from the local winery for the fermented grapes we consumed.

Sounds reasonable, right?  Of course not! Imagine if that was how businesses really operated.

Of course, when I do go out to eat, I pay the restaurant for my food. I don’t later get bills from the cook, the waiters, or the restaurant’s food suppliers.

When I take my car into the shop for a repair, I pay the shop. I do not get separate bills from the mechanic, the oil company, or the company who provides the testign equipment to the shop.

But it seems that the medical profession DOES operate that way. When I go see a doctor, I expect to pay for his services. But I don’t expect to get bills from umpteen other people that I have never heard of, who apparently have provided one service or other so that the doctor can do the job that I paid him to do.

Every other business in the country pays their own suppliers and sub-contractors. They build those costs into the prices that they charge us. This gives businesss an incentive to operate wisely and efficiently. If they use substandard parts or faily to employ the help they need, their business suffers, and they may well fold. On the other hand, they don’t spend money willy-nilly just because it IS their money. Successful businesses understand the trade off between frugality and quality. But doctor’s have no such incentive. Every time that they order a test or prescribe a medicine, it has no effect on their bottom line since they aren’t paying for it.  WE are.  And not only do we not have a choice, most times we are not even told about the charges until after the fact.  And that’s not right.

Of course, we all know the arguments the medical profession uses to support this practice:

The doctor’s only concern should be your health, and by removing the financial costs from the doctor’s pocketbook, we remove any financial biases from the doctor’s opinion.  Horse Hockey!   Isn’t the first question they ask you when you arrive about your insurance coverage? 

And since everyone’s health is different, the doctor really doesn’t know the cost ahead of time, and cannot quote a price.  More Poppycock! The doctor is in a far better posistion to make these estimates than we are. It would not be unreasonable for a dotcor to revise his estimate as the process goes on. Car repair shops do it all the time.

I am not about to propose that I know the solution to our health care crisis.  But I think that the first step should be to put at least some of the responsibility for the costs of health care into those individuals who make the decisions to incur those costs.  Or am I crazy?