The cost control collective action problem

Many times I’ve written that everyone believes we spend too much on health care in the U.S. but nobody treated by it thinks the care they receive is wasteful. I’m reasonably confident this assertion is true, but I’d feel better with some evidence to support it. Alternatively, I’d appreciate evidence that refutes it.

Finally, in the course of a Twitter discussion, someone (who?) offered evidence from a February 2013 Health Affairs paper by Roseanne Sommers and colleagues. Check it:

Some participants felt that since they had done nothing to cause the problem of unsustainable costs, they had little responsibility for helping solve it. One participant expressed this view as follows: “It’s asking us to bear the responsibility for the costs when we didn’t have a part in creating these costs in the first place. So [why am I as a patient] responsible for now reducing the costs, which I had no part in creating?”

It’s not me! It’s everyone else!

Some participants justified their choice by citing others’ noncooperation.

For example, one said: “Just because one person recycles, not everyone’s going to recycle. And how can I trust the rest of society to be as good as I’m being at that moment?” Another said, “Ideally, in a perfect world, it’d be nice to have a sit-down and see who has what conditions and who really needs—yeah, exactly. You can’t do that, so I agree with what they’re saying. It’s really sad, but it’s true. The country should work together, but ultimately everyone is just out to get their own.” […]

[S]ome participants’ comments reflected the belief that their personal interests should trump their communal responsibilities. These participants were unapologetically self-interested, as shown in this statement: “I don’t care about everybody else. I care about myself. So why are you trying to push something cheaper on me?”

In a comparable statement, another participant said, “I still have a lot of years to go, and I’m going to take the best medicine, the best treatment. And if it raises the costs, I’ll feel sorry. I don’t want the company to go out of business. I don’t want other people to suffer. But I’m sorry, I want to live. I’m not going to think about them.”

The care I get is valuable! Don’t give me something cheaper!

It’s only been in the last few years that I began to see that I am a vessel of wasteful care. I’ve purposefully canceled follow-up visits that seemed, well, wasteful. I don’t always fill prescriptions or take all the pills when I’m not convinced I need them. I’ve stopped seeing a doctor who talked me into a procedure I didn’t need. (I’m still embarrassed I didn’t stand up to him in the office. It’s very hard, even for me!)

Yet, I am sure that I don’t correctly judge the value of all the care I receive. I am sure I am  as much a part of the problem as the next patient. Yet, apart from the few exceptions I hinted at above, the care I get seems worthwhile to me. Doesn’t your care seem that way too? So, where’s the waste?

Oh yeah, it must be those other people.


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