What are we really fighting for… access or choice?

For some reason no one seems to be distinguishing between these two very different ideas in health care: ACCESS and CHOICE. All of this talk about socialized medicine creating less choice within our system and long waiting periods for care makes my head hurt. I can’t help but wonder why so many people are focused on choice in health care. Are they simply confused, or do they legitimately have their priorities mixed up?

Here’s a little story. I was speaking to an individual the other day about our current health care system. What was important to this person was that they never had anyone telling them what doctor to see or what services would be covered. So they made the choice to pay a ridiculous premium every month to ensure that their health care “choices” were never restricted.

I know this is an atypical situation. Most individuals at least have to choose an in-network provider for their primary care. But even then, everyone wants the ability to choose that physician.

Another example – benefits enrollment “season”. An employer that offers its employees health care generally gives them options, in terms of which health insurance plan they would like. Sure some plans come with shiny incentives and rewards for healthy behavior, but the choice is always there for the employee to make at their own discretion, regardless of which plans are being more readily promoted.

On October 17th Vidhya Alakeson (in Health Affairs Blog) started my mind on this subject in her article titled US Health Care: International Scholars Experience Our System – What They Would Change. She said:

The design of the policy prioritizes the act of choosing rather than the outcome of the choice. Not enough consideration is given to whether the time and effort required to make a choice are justified by the value created by the choice itself, or whether it is possible to make an informed decision. In our experience, this was the difference between choice for choice’s sake and choice that led to a greater sense of control.

I could not agree more. Especially with healthcare, having a choice in no way implies that you will have control over the situation or outcomes that head your way.

Truthfully, you can never really predict how much healthcare coverage you will need in a year. You can never really predict, even with adequate research, which physician will be the best match for you (that friendly physician with the nice new office may not provide his/her patients with the best care). You can probably never really know whether the health plan you chose will fit your health care needs over the upcoming year.

So here’s my question. What’s really important at the end of the day, that you got to choose your provider or insurance plan, or that you had access to care when you needed it?

I would imagine the latter would be more popular… but then again I’m writing this for a reason.

For what its worth, here’s my opinion:

So many people are scared of universal healthcare or socialized medicine. This is not where our solutions lie… focus your energy elsewhere. I challenge those people to stop criticizing and start suggesting solutions. I challenge those individuals to be smarter healthcare consumers and stop running to the doctor every time they have the sniffles.

I will admit that access is an uphill battle. Once you extend healthcare to those millions of children and older Americans lacking coverage, you still face quality issues, treatment compliance, prescription costs… the list goes on.

However, I still advocate access over choice as deserving more attention.

I know I am guilty of being part of the problem. I paid the $20 co-pay every time I saw the doctor for the sniffles. Never once did I consider how much my office visit really cost or who was footing the other portion of my bill.

Now I am proud to say that I am making an effort to be part of the solution (rather than the problem). I am officially on my way to being an educated and thoughtful healthcare consumer. You all should join me, the air is pretty clear over here.

At the end of the day what’s really important is that I have quality medical care available to me when I need it. At the end of the day what should be a priority for Americans is finding a way to provide quality medical care to all its citizens. Stop being so gluttonous. Take a step back from the medical buffet. Remember that over-consuming is never a good idea.

My advice is to share the wealth… medical care that is. The more you focus on being a better healthcare consumer, the more room you leave at the buffet for those individuals who are truly starving.

For some reason I believe there is plenty of food for everyone. All we have to do is learn to stop going back for seconds… thirds…

No one ever said change was easy.