Health Reform: Other People’s Money(OPM), Other People’s Physicians (OPP), But Not Your Own Money(YOM) or Their Physicians (TP)

July 11, 2011- It’s a natural human impulse. Most of us favor anything that benefits us but uses other people’s money (OPM).

That’s the appeal of government entitlement programs. That’s why people don’t want any tampering with “My Medicare.” You may have contributed to only 1/3 of its costs, while “other people” must cough up the other 2/3 of the money. Never mind the details. This is an irresistible bargain.

The same logic applies to Other People’s Physicians (OPP). As long as you have your own personal private physician, let other people be served other people’s physicians – physicians in government programs, in community health clinics, in VA hospitals, in hospital-owned practices, in large groups, in medical home teams, in accountable care organizations, in academic centers, in structured integrated megagroups of every ilk.

But when it comes to “me,” I want my own private doctor – someone I can confide in, someone I can contact directly, someone who will keep my information confidential and my situation, someone to whom I can turn at critical moments, someone who understands me, someone who can guide me through bureaucratic thickets, someone who is always available, someone who cares about me rather than the details of my health plan coverage, someone who knows my personal story, someone who can explain my problem to me, someone who can direct to the best specialist for my particular problem. I want Marcus Welby on steroids.

“Private physician” organizations are popping up all over America to fulfill this yearning for individual personal care. These organizations take the form of doctors offering “out-of-pocket” care skirting third party restrictions, “direct care” in the form of concierge practices, and even physicians in “out-of-country” medical tourism organizations not restricted by U.S. regulations.

But access to private physicians is a tough sell politically, largely because you’re using your own money (YOM) to get what you want and you think you deserve.

Which leads me to logical conclusion. Government, here or elsewhere on the globe, will never have the human or money resources to meet demands for care using Other People’s Money.

So things always happen.

One, The Inevitable Great Hypocrisy. In every country, those with the means and needs bypass the government bureaucracy to gain access to a private physician. Do you honestly think high government officials, or Wall Street tycoons, or other sick people with means will go to a public health, Medicaid, or other government-sponsored clinic rather than seek private personal care?

Two, The Inevitable Two Tiered System. Let’s be honest. In the U.S. and elsewhere, people will do what they have to do to get the care they think they need. It’s my body and my health. It's survival instinct. That’s why private contracting outside of third parties is inevitable.