You may be familiar with a biopsy. We take a piece of tissue from some bodily organ—such as the skin—and examine it in a laboratory to look for signs of cancer, autoimmune disease, or other illness.
A sardonic medical joke holds that when patients enter a hospital or doctor's office, one of the first procedures is the "wallet biopsy"—checking their ability to pay.
The consequences flow from there. Take colon cancer screening for asymptomatic patients. Most people should start with a stool test. Yet those with comprehensive insurance are more likely to be referred directly to colonoscopy.
In the dermatology office, insurance coverage often determines whether you'll be treated with relatively affordable interventions for skin cancer—say, a topical cream—or whether you'll be offered photodynamic therapy ("blue light" treatment), which can cost up to $4,000 per session.
Here's the irony: more expensive doesn't always mean better. Any treatment carries its own adverse effects, including expensive ones like colonoscopy. Many physicians, when they get back pain themselves, avoid certain spinal surgeries.
One positive side, the healthy wallet does get the most valuable thing of all-the doctor's attention.
The result: our medical care system doesn't deliver care efficiently. Those with robust coverage feast at a bountiful table though the fare isn't always nourishing. Those on a budget have trouble getting the basics.
Let's pay less attention to the wallet biopsy.