If you've watched television at all since 1995, you've probably seen Wilford Brimley as the spokesperson for Liberty Medical's diabetes testing supplies. Brimley actually pronounces it like "Dia-Beet-is" or "Di-uh-Beet-us" and that fact alone has gained him a cult following. Brimley tells people that if they, like him, have diabetes, it is important for them to regularly check their blood sugar, and that Liberty Medical will send testing supplies to their home at no cost to them and will bill Medicare on their behalf. What's wrong with this picture? Well, it pretty much encapsulates everything that's wrong the health care system: consumers are insulated from the costs of their care, providers are motivated to make a profit, and Wilford Brimley looks like a walrus. In case you haven't seen the video, take a look:
All you have to do is call the number, and Liberty Medical takes care of the rest. Sound too good to be true? It's not. Liberty Medical's making a ton of money off of this. In fact, they make so much money off of it that they're able to hire Wilford "The Walrus" Brimley and run these ads on television all the time. What you're witnessing is nothing more than a "Medicare Mill." People need services, so the supplier of those services markets itself to them aggressively, and may even suggest that there are other things the people need -- even if that's not entirely true. If Medicare will cover it (i.e., if Liberty Medical can get paid) and there's no cost to you, aren't you likely to agree to letting them send the stuff to you? After all, it doesn't cost you anything, so how can you lose?
This is precisely what happens when a third-party payer gets involved in the patient-provider relationship. The patient trusts the provider to provide the goods and services that are in the patient's best interests. The provider strives to provide the best care to the patient possible, but also makes a living doing it, and therefore seeks -- like any business -- to maximize profits. To the extent that the insurer insulates the patient from costs and pays the provider, we have the potential for these types of Liberty Medical operations that drive up costs and spending for unnecessary care. Now, that doesn't mean that we don't need the risk pooling mechanism of insurance. Rather, it means that we need heavy government regulation of insurers. That's the only way out of a situation where insurers either "Die-or-beat-us."