The policy journal Health Affairs has a great first-hand account from a physician who visited the emergency room when he came down with shingles. The doc, who teaches at Stony Brook University, got caught in a maze of over testing and ran up an unnecessary $9,000 bill.
You should read the entire story when you get a chance, but he concludes:
One thing’s for sure: I’ve lost the smugness and condescension I often felt when listening to others’ stories about being trapped by the system and manipulated into excessively complex and specialized medical situations. Unlike most of my patients, I actually knew what my diagnosis was and what to do about it, but I learned how difficult it is to remain objective when you’re feeling very sick. Maybe I should have been more assertive. Instead, I wound up as a poster boy for excessive medicine. I understand now how all those people could have been so gullible, so easily manipulated by the system. Now that I’m one of them, that is.
The story is important because the physician was not given more and more tests because the emergency room docs and specialists were afraid of getting sued. And given his fear and vulnerability, requiring the patient to pay more out-of-pocket would not have changed the circumstances. When a specialist recommends testing for a brain tumor paying more out-of-pocket is unlikely to deter anyone.
What we need is better coordination of care. Someone rational thinking about the whole patient. And this story is a good example of how fixing health care is much more complicated than the simple talking points offered by conservative critics who push health savings accounts and tort reform.