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The practice of medicine

Today I received a political mailing, targeting a candidate on healthcare.

“Who should be in charge of YOUR healthcare decisions?,” it asks. “Politician [name] OR Doctors?” The flier then criticizes the politician in question for votes to create a state insurance exchange.

It’s a legitimate criticism, but nothing new. The political process has been making health-related decisions for a long time, including scope-of-practice laws, certificate-of-need requirements, and insurance regulations.

You might say, though, that insurance companies are also involved in the practice of medicine. That, in turn, goes back to politics. Not only do state governments regulate health insurance, but the federal government has encouraged a “fourth-party” system of health care financing that makes health care a much more complicated affair than simply doctor and patient.

Fourth-party? Yes. Avik Roy explains:

For most Americans, health care looks something like this: A patient purchases health insurance, or receives it from his employer. The insurer then directs the patient to use physicians in its network, with whom it has negotiated reimbursement rates. The patient is given little or no information about the comparative cost or quality of any particular doctor. The patient then visits his doctor. After an interview and an examination, the physician orders tests, procedures, or medications on the patient’s behalf. The insurance company reimburses the doctor for a large share of these costs, though it might occasionally haggle if it feels the doctor has spent too much on the patient. The patient receives a bill in the mail from the insurer for his part of the expenditure; that bill is only vaguely related to the services rendered to the patient, and is generally presented in a way that makes it impossible to decipher the relationship between services and costs.

Patient. Insurance company. Employer. Medical professional. Four parties.

Employer-sponsored insurance is in large measure a create of the federal tax code. ObamaCare, or the ACA if you will, could in theory lead us toward a system of personal, portable insurance. But there are so many poor features of it that patients are going to be mired in public and private bureaucracies for quite some time.