Social Contracts and the Choice to "Opt Out"

Since important national budget issues are already being addressed, what is immediately at stake? The social contracts which involve mutual coordination for time based product, aren't just important for citizens, but also national prosperity. One example involves a study which gained attention last November. The researchers highlighted "opting out" which occurs in emergency rooms. From CNBC:

A new study that looked at more than 2 million emergency department visits found that more than 1 in five patients who went to ERs within their health-insurance networks end up being treated by an "out-of-network" doctor - and thus exposed to additional charges not covered by their insurance plan. 

And the average out-of-network bill those patients faces, unless their insurance plan ultimately agreed to cover it, was more than $622...But the bills can be much higher than that, according to the researchers, who pointed out that one patient they were aware of faced a potential balance bill of more than $19,600. 

Still, this is only a limited opt out example, given the fact physicians already have limited participation with either Medicare or Medicaid patients. Often, individuals with chronic illness and/or disability, may go months at a time without a primary care provider, should they lose one. Or when they finally locate another, may need to drive several hours one way, in order to reach appointments. It's not always possible to gain healthcare provision in nearby cities, as physicians who take Medicare and Medicaid tend to have very full schedules.

Traveling long distances for healthcare can be difficult enough for those who still have reliable transportation. But as health declines, one faces additional uncertainties regarding doctor's visits, should their vehicles have some of the same ongoing maintenance issues that a physical body may face. If there's one thing worse than being stranded on the side of the road with no one nearby to call on, it's being stranded on the side of the road in approaching nightfall, with a patient in the car who really should be in the hospital. Yes I've been there, and after circumstance like this, decades of driving confidence can flat out disappear.

Where opt out for the physician is a matter of being able to freely choose patients, opting out for others may simply mean leaving the participation framework that exists. Now, an even larger opting out issue is at stake, as Washington contemplates a partial opting out for Medicaid provisions. While the extent of block grants involved is uncertain, the bigger message is clear: as healthcare gradually reverts to the states, policy makers can finally achieve much needed cost reductions. There's just one problem. As the healthcare marketplace is currently designed, national output is more likely to suffer, as no one really knows the kinds of supply and demand that would exist were there free market conditions for healthcare.

These supply problems originate with the ways in which healthcare became a social contract in the twentieth century - especially in the U.S. Since the opting out process realistically only goes one way (doctors and healthcare providers choose the patients they can serve with their limited time), it is most inefficient and illogical. Even though doctors and healthcare providers are quite reasonable in making the most of their time scarcity, other citizens cannot make good collective use of their time to amend the fact that existing hours on the part of physicians and healthcare providers are severely limited. This lack of citizen options re rights to produce/apply knowledge for healing, is all the more illogical, since there is little if any cultural acceptance for suicide in the U.S.

Ultimately, if democracy is to remain viable, everyone needs realistic opting out and opting in for time based product processes. Citizens with low incomes need the same formal opt out options that healthcare workers have, so they can to take part in local "opt in" system alternatives. Opt in alternatives would mean knowing one's budget need not be devastated after years of resisting healthcare markets designed for higher income, only to need them anyway, in the event of emergency or serious illness.

Knowledge use systems as a new form of social contract, would encourage further development of applied and practical knowledge. Doing so is all the more important, given the fact that block grants for states would run their course long before existing markets are addressed. With the budget cutting in Washington, there's little time to lose, for citizens to gain the kinds of production rights that could secure knowledge use and prosperity, well into the future.