Saving Your Own Skin

[groovedaddy]

The visceral phrase “skin in the game” keeps popping up in discussions of American health care policy. It’s the idea that if patients spend their own money on care, they will spend it more carefully, and health care costs will go down. Conservatives worry that as the government becomes more involved with health care, patients will become less responsible about costs because the money being spent — their “skin” — is not their own.

The phrase reminds me of a patient whose skin was literally in the game, despite having good insurance. He had been off and on the hospital floor for so many months that we all knew about his fondness for ’60s rock ’n’ roll, his perceptive and stalwart wife, the dearly loved young children he so rarely got to see, the outside work he kept up with in the hospital. First there had been a diagnosis of leukemia. Then he’d relapsed, telling me with a resigned shake of the head, “Well, that leukemia came back, Theresa.” His only option for a possible cure was an allogeneic stem cell transplant — a donation of cells from another person — and he got one.

Then he developed graft-versus-host disease of the skin. In a reversal of the kind of rejection that can happen with solid-organ transplants, where a patient’s immune system attacks the new organ, with graft-versus-host the donated stem cells, called the graft, attack the patient’s body. The condition is not uncommon, but it comes in grades. The patient had Grade 4, the worst, which was typically fatal.
His skin sloughed off. Desquamation is the medical term, but it doesn’t capture how horrid the patient’s situation was. Areas of skin on his face and legs essentially disappeared, leaving raw patches dark with blood.

http://opinionator.blogs.nytimes.com/2012/10/27/saving-your-own-skin/?nl=todaysheadlines&emc=edit_th_20121028

[Warpy]

1. Republicanism just plain does not work

The deductibles and copays might work had wages kept pace with the true rate of inflation, but they didn't. Working people saw their purchasing power eroded every year by inflation while wages stayed flat or even decreased as jobs were offshored and only McJobs remained.

Now the deductibles and copays don't insure that patients watch the cost of what they're getting more carefully, it means that most must forgo care completely because they simply can't afford it.

It's just another example of how everything comes down to wages and how they've been systematically depressed since the late 70s, when inflation from oil shocks was blamed on people who earned "too much" money for their labor.

If you haven't gone to the polls yet, please go. Vote them out. It doesn't matter if you live in a red state, be heard. I think some of you might be surprised on the night of Nov. 6.

[SheilaT]

2. In theory that's a good idea.

In practice, it's almost impossible to comparison shop for medical services. Even if you are truly out on the open market because you have no insurance. Medical situations are often a crisis: you break a leg, you have an infection, you have a heart attack. None of those are quite like you need a new set of tires and you can call various tire places and figure out the best deal.

Medical care bears almost no resemblance to normal consumer activity. It bears a distant resemblance to buying a car or a house. Most people buy a house at most two or three times in their lives. Cars, maybe every five or seven years. I actually have bought slightly more houses, and helped out in a whole lot more car purchases than the average person, so I actually enjoy doing both. But even with those, you have the opportunity to comparison shop in a way that almost never would be possible when "purchasing" health care, such as when you need an emergency appendectomy, or you've been in a car crash, or you gash yourself on broken glass. About the only time you can plan ahead for some kind of health care cost is with childbirth. Now, if medical care were truly organized like other consumer products, and expectant mom could visit any number of free-standing birthing places, asses what they have to offer and their costs, maybe even negotiate a better price (as with a car or home) and then eventually give birth there.

But our current medical system does not allow that kind of comparison shopping. If you have any kind of health care coverage, you have some sort of restrictions about where you can go for treatment, or you pay a whole lot more money. And god help you if you honestly thought your situation was an emergency and went to the nearest ER and your health care company didn't (looking at this weeks or months afterwards) didn't think it was a real emergency.

In any case, no matter how you look at it, health care coverage cannot ever be in the same category as normal consumer purchases of any kind.