This NY Times story on long-distance runners and medical insurers provides a case study on why productive reform of the U.S. health care finance sector so difficult.

As noted many times on this blog, long-distance running is not healthy. Thus, as the article notes, medical insurers are beginning to balk at insuring long-distance runners.

However, the myth that long-distance running is healthy remains firmly implanted in the American psyche. So, the medical insurers – not wanting to be perceived as refusing to cover injuries resulting from supposedly healthy activity – are trying to figure out ways to cover the runners.

And, of course, Obamacare is going to require that insurers cover consumers who engage in injury-causing activities.

Meanwhile, the runners delude themselves that they are engaging in a healthy activity while advocating that insurers essentially provide them insulation (rather than real insurance) from the cost of dealing with the unhealthy effects of their activity.

Don’t get me wrong. Folks should be able to enjoy long-distance running as either exercise or a recreational activity (those are two different things, but that’s for another post). My anecdotal observation is that most runners don’t actually appear to enjoy the activity — the delusion that the benefits of long-distance running outweigh the costs apparently pushes them through the displeasure.

But if folks elect to take the risk of injury from long-distance running, then they should have to bear the cost of at least the non-catastrophic damages resulting from that risk. And insurers should be free to elect not to cover consumers who engage in such risky behavior. Shifting the cost of that risk to insurers (who pass it along to the rest of us) simply encourages runners to avoid confronting the myth that they are engaging in healthy activity.

As the late Milton Friedman was fond of saying, consumers will consume as much health care as they can so long as someone else is paying for it.

One of the numerous inefficiencies of the American health care finance system is that hospitals have been forced to pay high compensation to attract doctors into emergency room care.

The primary reason for this has been that many uninsured and underinsured consumers use the ER for non-emergency medical matters that would be better and more efficiently handled by an internist or family practitioner in their private office. This disturbing trend has been growing for many years and likely will be made even worse by Obamacare.

Turns out that the ER doc-as-primary-care-physician is also having some unintended consequences with regard to patients, as related by an internist/hospitalist friend of mine:

So, I get a call from the ER today – new doc fresh out of the ER training program tells me she has a patient there she wants me to admit for a cardiac workup.

Says that the patient has a history of “heart problems” and that the patient said that she was having chest pain “just like before my bypass.”

So, I go down to the ER – I look at the patient’s chart and note that her primary complaint when she arrived there was fever and vomiting.  I note that her cardiac evaluation so far was normal.  I looked at her EKG – normal.  I pulled up her chest x-ray – normal. And no sign of any telltale median sternotomy wires that are standard post-CABG.  Hmm…

So, I go in to talk to the patient.  She tells me that she has “chest pain,” and epigastric pain, and fever, and chills, and nausea, and vomiting. I examine her and note that there is no CABG scar on her chest.  Hmm….

So, I ask her, “Tell me about your bypass.”

“You mean my gastric bypass?”

Turns out she never has had any heart problems.

Turns out she had a cardiac cath 15 months ago before her gastric surgery – stone cold normal.

Turns out the ER doc stopped listening as soon as she heard “chest pain” and “bypass.”

So, I put her in the hospital to treat her viral gastroenteritis with IV fluids and nausea meds.  And I will sent her home in the morning, feeling all better.

And I take solace in the fact that ER docs are paid at least 50% more than I am.

Well, not really, about the solace thing, that is .  .  .

To make matters worse, in previous times, the ER doctor’s superiors would have castigated her for her stupidity and intellectual laziness.  However, if that were to occur today, each of the doctors criticizing the ER doc would probably be labeled as a “disruptive physician” and referred to a series of sensitivity counseling sessions.

This is not going to turn out well.