Changing behaviors isn’t easy.

What I tend to wax philosophic about is the cost control mechanism that is in use in almost every universal care system. It is one of the best and most effective mechanisms know in controlling costs, and has no measurable negative effect on the quality of care.

Our insurers started to use it in the 1980’s, but we hated being told “no” so much that most states outlawed it in things called Patient Bills of Rights.

I am, of course, referring to the “gatekeeper” mechanism, where if you feel you have a problem, you go first to your “gatekeeper” (family practitioner, GP, or internist) and if THEY can treat you, they do (cheaper), and if they can’t, THEY write an order for the (pricier) specialists.

What does it say about us that we accepted substantially higher prices because we didn’t want to be inconvenienced?