The Patient Laughed

It was a scene that is played out daily in Greater Cleveland. The participants may change, but the message is always the same – The Rules Apply to Everyone But ME.

A physician, we’ll call her Dr. Peg, was discharging a patient from one of our local hospitals (Don’t ask me which one). The subject of insurance came up. The patient laughed and said that he had none. Dr. Peg suggested Healthcare.gov since the patient could now purchase coverage even with his preexisting conditions. He saw no reason to buy insurance. And if there is a penalty, he’ll just pay it.

Not only would the patient not waste any money on insurance, he also knew how much medication he could demand on his way out the door. Dr. Peg looked down in disgust at his paperwork. “Dave”, she later told me, “This guy lives in a nicer neighborhood than me!”

Did the sharpy get his discharge prescriptions? Absolutely. The hospital knew that the medications were cheaper than the malpractice suit.

One of the elements of the Patient Protection and Affordable Care Act (PPACA or Obamacare) is the Individual Mandate, the rule that everyone needs to have insurance. As anyone who has ever been hit by an uninsured motorist can attest, no law and no penalty, no matter how severe, will ever force everyone to be responsible. But that doesn’t mean that we shouldn’t try.

The Individual Mandate was a significant part of the Republican Party’s response to Hilary Clinton’s healthcare plan in the early 1990’s. The Individual Mandate reappeared in 2003 when the Republicans created Medicare Part D (Rx). Failing to enroll in Medicare Part D when first eligible may result in a lifetime penalty.

How much does the penalty (tax) have to be to force someone to be personally responsible? It may be a Risk / Reward issue. The upside of the PPACA has, for me, been the opportunity to easily insure the previously challenged. Sick? Injured? Doesn’t matter. One of my biggest frustrations has been my encounters with people who believe that insurance is for suckers. They think that it is our job, yours and mine, to cover their healthcare costs so that they can spend their money on fun stuff.

It is not our job.

Dr. Peg was really angry. “Obamacare was supposed to cure this”, she told me. And it might. But remember, every time you see a politician, TV ad, or internet spot discouraging young, healthy Americans from acquiring health insurance, we are institutionalizing this ME First / ME Always attitude. We need everyone in the system. And we need them now, before they meet Dr. Peg.

DAVE

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