Wednesday, July 22, 2009

Health Care and Car Repairs

I have lived in the same Chicago suburb for going on twenty-five years. For the first twenty of those years, I never had a car mechanic that I really trusted. I would ask friends who they used but when I had to have a car fixed, I was never sure whether I was getting taken. I could compare prices, but the problem was that I had no way to be sure whether the mechanic was finding extra things wrong just to run up the bill. It's not that I am particularly ignorant about cars either. Back in the 1970's I used to help my brother with the various $200 clunkers he liked to buy. Engines were much less complicated in those days.

A few years back, however, I got lucky. One of my son's friend's father is a mechanic and he recommended a mechanic I had never heard of before. I have been thrilled ever since. He does the work I ask him to do without coming up with a list of things that need to be fixed every time I bring a car in. As both my wife and I have cars that are over ten years old, I am sure that he has saved me a lot of money. The couple times he has advised me to have something fixed other than the problem for which I brought the car in, I have been reasonably confident that it was something that truly needed to be done.

I was thinking about this today when I was considering the absurdity of the notion that health care costs could be brought down by free market forces if people shopped more wisely. It took me twenty years to find a mechanic I trust because I lack the expertise to challenge a mechanic's judgment. How could I ever decide whether a doctor was ordering unnecessary tests to line his own pockets?


  1. Apples and oranges. Doctors are trained and licensed. No, they're not all of equal quality, but they didn't learn medicine under a shade tree.

    They also peer review each other (at least in some specialties).

    Finally, insurance companies do quite a bit (an unreal amount, actually) of vetting before they put a doctor on their list of choices.

    But you're right in part. That "market" approach assumes that most physicians are of comparable quality and you only have to find the one who will do the work for a price that will make you happy.

    That is not the only way to approach the market, though. It's more like buying car insurance. I don't show up and work and someone hands me my car insurance policy. I decide what I want my insurance to cover, and then I talk to a few companies and find out what they're willing to charge. If the cheapest is also a bit of an unknown, well I have to decide if I'm willing to take that risk.

    I have a large deductable on a policy that doesn't include rentals or roadside assistance, so I pay lower premiums than someone who wants the works. It's a decision I make to get insurance that is affordable to me.

    And if I make unnecessary claims, my insurance will go up. So I take care of little things myself -- something I wouldn't do if my car insurance was invisible to me like my medical insurance.

  2. Unfortunately, most people lack the expertise to decide which medical procedures are necessary and which ones are not. I can look at the dent in my car and determine whether it bothers me enough to make a claim on my insurance to get it repaired (very few of them do). However, if I decide, as people in both America and Britain often do, that the ache in my joints is something I can live with, I may be crippled with RA before I know what hit me.