According to a Wall Street Journal article, Americans are foregoing treatment more often than in the past. These are hard numbers based on insurance companies and other health providers.

There are several reasons given for the decline. First, the rise of the ranks of the unemployed. Second, many American businesses and families now buy insurance with extremely high deductibles. If you have to pay the first thousand dollars of hospitalization, you are more likely to stay away from the hospital no matter what you have.

What are the ethical dimensions of this?

Some would argue that increasing costs discourages people from seeking care for minor problems like colds and that it will also encourage people to adopt healthier life styles. I have several problems with this. The most significant is where are your numbers indicating that increasing costs has either of these effects, and if you have such numbers, at what point do people with serious problems stop coming in?

The patients are the stakeholders in this debate. Increasing costs for doctor visits and hospital stay does bring down the costs of health care. But is that the goal of health care – the least possible care for the greatest sum of money?

Health care is not like most products. Let’s say for example that I want to buy a car. I can buy a used one, a new one or seek some kind of specialty model. I have many, many choices as to what I can buy and what characteristics it has. I also can just keep driving my old car or seek public transportation or walk if that’s possible. If you don’t medical care when you need it, you suffer. Sometimes, you die. It’s bad enough if it’s you. It’s worse if it is your child or your spouse.

You can live without some kinds of medical care. You can give up yearly physicals and treatment for high blood pressure and other long term illnesses. You can decide to go to the hospital only if you cannot recover on your own and spend a week or more in pain to see if you can do it (I’ve done that several times). Are encouraging people to do these things wise? What effect does discouraging medical care have on people’s lives and on health care costs over the long term?

What’s are the ethical implications? Is there an inherent problem with private medical care? The disproportionate negotiating power is extreme under these circumstances. Picture this. You are in bed in a hospital. You can’t breath right. Every time you try to take in air, it takes a tremendous effort. You feel yourself gradually, slowly suffocating. How much will you pay to make it stop? How much would you pay for a minute without that pain?

Tell me. Under those kinds of circumstances, are you in a position of equality in negotiating with a hospital over your care?

I didn’t think so. I want a balance between discouraging frivolous hospital visits (if the data indicates that there is such a problem) but not at the costs of people giving up essential health care for themselves and their children.

James Pilant