Michael Arnold Glueck and Robert J. Cihak
Tuesday, June 3, 2003

Someone (an economist, no doubt) once remarked that the plural of "anecdote" is "data." Now, two anecdotes doth not a data make – although they do make more than a datum. However, when it comes to what economists sometimes call "rational ignorance," the two anecdotes presented here may well resemble a whole lot more.

In economics, rational ignorance refers to deliberate and logical decisions not to become informed about something. For example, you can be rationally ignorant of very important political and cultural affairs. Sure, it matters what the government or the church is doing, but if you can't influence the process or the outcome, you're usually better off spending your time on things you can impact.

But rational ignorance can also refer to deliberate unwillingness to understand something, lest it affect what you perceive to be your "interests." Or, as Radar says on M*A*S*H, "Some stuff you're better off not knowing."

Or are you?

Anecdote First

Dr. Del Meyer is a Sacramento, Calif., lung specialist who e-publishes a weekly review of medical policy issues (www.medicaltuesday.net). One of his patients is a retired military man. Dr. Meyer sees him as a private patient, covered by private insurance. But this patient is also treated at military and Veterans Administration hospitals for the same conditions.

When Dr. Meyer pointed out that having three non-consulting doctors might be hazardous to his health, the patient shrugged it off. Health care in triplicate had value to him.

But, writes Dr. Meyer, "When I tried to point out that he was duplicating if not triplicating his health care costs, he begged to differ. He said that the private insurance was a benefit of his previous employment and, therefore, didn't cost anything. He also felt that he had earned the right to obtain the services of the military and VA government hospitals and did not see it as an unnecessary cost." [http://www.medicaltuesday.net/Apr803.html]

We do not dispute that this patient was entitled to the care he received. But we do hold that he was "rationally ignorant" of the fact that out-of-pocket costs are not the only costs involved here. In the end, this person would bear a share of it ... perhaps when total costs of medical care grow so great that government and private insurers have to start saying no.

Or have they already?

Anecdote Second

Washington Post writer Anne Applebaum writes about what happened when her 5-year-old son tumbled off a staircase banister, followed by screams of "I can't walk!" Ms. Applebaum, like any good mother, took him to the hospital, where "the emergency room staff went into high gear: X-rays, Cat scan, intravenous drip, blood tests, urine tests, EKG."

These good folks plunged into a rational ignorance all their own, perhaps a more complex and justifiable form than in the first anecdote.

Writes Ms. Applebaum, "They must have calculated, although they denied it when I asked, that mothers of five-year-olds with undetected injuries are prone to lawsuits. They must have realized I had insurance. So – just to be certain – they carried out every conceivable test, even some that might have been unnecessary, or very expensive, or both."

Yes, the fact that she had insurance made it easier for her to let the tab run; it also allowed the doctors to practice "defensive medicine." But again, their belief that it cost them nothing was, in the long run, as wrong as the retired military patient's sense that, because he was entitled to his benefits, he should use them to the max.

So, what's the antidote for rational ignorance? Certainly not a crash course in the economics of health care – which can be very bad for your mental health. Rather, the antidote lies in understanding what economists mean by the "fallacy of composition." This holds, in essence, that things are more than, and often very different from, their parts.

For example, if a woman saves 50 percent of her income, she generally grows more financially secure. If everybody in the nation suddenly starts saving at anything near that rate, the result is a depression catastrophic for all.

Or, to put it another way, there is no such thing as free medical care. Which is why most of us are paying far too much.

For those who wish to become a bit less rationally ignorant on this matter, we suggest a simple exercise. Find out how much your employer pays for your health coverage. Then ask yourself, how much do I want to spend – or how much can I afford to spend – on health insurance, on groceries, on my kids, their education, etc.?

If you want to translate those thousands of medical coverage dollars into your own reality, work with your employer to get medical coverage that meets your family's budget priorities – and most likely have several thousands more dollars to take home for your family.

The choice is yours: You can choose and practice rational medical ignorance – or you can choose enlightenment.

Michael Arnold Glueck, M.D., is a multiple-award-winning writer who comments on medical-legal issues. Robert J. Cihak, M.D., is a former president of the Association of American Physicians and Surgeons.

Contact Drs. Glueck and Cihak by e-mail.

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