'Moral hazard'? Please, don't even start

You know how some ideas just won't die? The notion that there's a "moral hazard" problem in healthcare--that unless you weigh people down with heavy co-pays and deductibles they'll thoughtlessly chug down healthcare like frat boys guzzling beer at a kegger--seems to be one of the most enduring ones. This foolish idea has been disproven again and again and again by academic studies where healthcare is concerned. But the healthcare business still operates as though this assumption should dictate how the system works.

Sadly, no matter what scholarly evidence says, there's still a hard-core group of believers out there who assume that a) people are making rational choices about healthcare spending, and that b) all things being equal, they're capable of reducing health system costs by making those wise choices. Such believers also assume that you have to force these prudent choices on them (right, the prudent choice between one badly-needed drug and another), because otherwise, people would, uh, have all of their needs met in an orgiastic festival of healthcare consumption. And that's a moral hazard, young lady! It rots the teeth and destroys the American character!

Look, even without a PhD in economics to wave around, I think it's pretty easy to defeat those premises with simple logic.

First, are people making rational choices about healthcare? Not on your life. Sure, Dr. Mom can sometimes figure out the basics, such as whether Junior really can safely stay in bed with this cold, or if he needs to visit the doctor today, but how about when his telltale cough and low fever are getting just a bit worse? What about if the only doctor who's got an opening today is $50 more for a visit than the guy across town. Is it more rational to wait or to get Billy in to see Dr. Expensive? Does she really have the means to tell?

And what about this "all thing being equal?" Should Dr. Mom put off preventive care and pay for Billy's amoxicillin today, or should she let Billy's strep throat fester for a day and get Junior his shots? In other words, does Dr. Mom have the means to evaluate what tradeoffs make sense, even with the help of, say, a nurse line or WebMD.com? I'd say "hell no." (Even I don't know, despite writing about medicine every day, when it's my turn to be Dr. Mom to my two young sons.)

Lord, CDHPs are cruel. Not only do they force consumers to try and fund first-dollar healthcare with money they generally don't have, they also try to shift the blame for rising healthcare costs to patients who are only experiencing routine illnesses. It's a nice one-two punch.

I say, just put the moral hazard back where it belongs, on the shoulders of doctors and hospitals. After all, they're the ones who stand to make money every time we consumers take a pill or get a test. Acting as though patients need to be discouraged from staying healthy is just a massive piece of misdirection. Uh, see those doctors? The rabbit's over there, folks. - Anne