Putting my money (literally) where my mouth is

As a Canadian, I'm used to the idea of going to the doctor for a checkup (or whatever) and no money changing hands: I present my Health card and the financial side of things is invisible to me as a patient. It's very easy to get into the notion that healthcare is "free", because on a practical level that's exactly how it appears. For those of you living in jurisdictions where you don't see a doctor without reaching for your debit card or chequebook, this may sound like a great innovation.

When the system works well, everyone is happy. Unfortunately, the system is designed to oscillate out of control very quickly indeed: there are no limits to the demand for healthcare, and because the costs are not borne directly by the patients, there is no dampener on the demand from the payer. Canadians like to think of our system as being fair: everyone has equal access to healthcare. This is true, to a degree: it is against the law to "jump the queue" and pay directly to get faster treatment. As a device to prevent corruption, this provides doctors with a good reason not to stray outside the system, for fear of the penalties for being caught taking payment directly.

Dental care is not currently part of our government-run healthcare system, and we're much more familiar with the idea of paying for services. Many of us have some health insurance coverage through our employers which pays some or all of the costs of regular dental care. My employer, for example, pays a significant share of the costs for me and my family.

My employer, however, has a strong incentive to purchase group insurance for their employees through whichever insurance company offers the best deal: there is a competitive market for providing group health insurance. I assume that my company is satisfied with the trade-off they've made between the cost of providing the benefit and the degree of coverage the plan provides to me and the other employees.

A specific example, and this relates to the title for this posting, is that the insurance coverage we have provides for twice-yearly cleaning and scaling treatments. My dentist has recommended that I come in more frequently (as a kid, and even as a young adult, I had terrible dental hygiene: I've spent more hours in dental chairs as a "mature" adult as a result).

Any additional care, beyond what my insurance provides, comes out of my pocket. And this is right: I'm the one who benefits — although I find it hard to think of it as a benefit as the dental hygienist is taking a pick and shovel to my gumline!

This is where the natural limits to healthcare in general should also fall: without some patient buy-in (and I mean that literally, as in cash-on-the-barrel), we will never manage to reign in the out-of-control costs of the overall healthcare system. As it is, we ration by time, and some people suffer for months before the system can take them in their turn and fix whatever needs fixing. For some, that means living in pain that is totally unnecessary. If that doesn't strike you as being wrong, then we probably have diametrically opposed ideas about human dignity.