Doggy Care

Did you know that almost anything doctors can do for humans they can do for our furry friends?  MRI scans, renal dialysis, medication for arthritis, you name it-what’s good enough for us is good enough for Fido.  Eli Lilly is even marketing a new drug called Reconcile, which is Prozac for pets.

Pet care is big business.  Americans spend about $50 billion a year on their pets and one-third of that amount is for health care.  Further, most dogs and cats have health problems.  Three-fourths of dog owners and more than half of all cat owners are giving their pets some sort of medication.

So here is the obvious question:

Why does the market for pet care seem to work so much better than the market for human care?  Not that I pay a great deal of attention to such things, but I believe it’s fair to say that:

  • No one is saying the market for pet care is “broken” or in “crisis.”
  • No one is saying that the market cannot work for pet care.
  • No one is calling for mandatory pet health insurance.
  • No one is calling for single-payer health insurance for pets.

But why not?

The answer is not obvious.  Most pet owners view their pets as a member of the family.

They agonize over health care decisions for a pet as much as they might agonize over similar decisions for a child.  End-of-life decisions can be painful and difficult for anyone.

Yet, if we agree that the veterinary market works better, could it be used as a model to reform the human care system?

I’ll reserve comment for the time being and let readers weigh in.

Post Script:

  1. Here are estimates of how many pets there are and how much we spend on them.
  2. Here is Richard Posner on Leona Helmsley’s gift of $12 million to her own dog (I used to watch her feed him at the table in the dining room of the Central Park South hotel) and $5 billion to $8 billion for other dogs.
  3. Here is Gary Becker on the same topic.
  4. Here is a restaurant with a menu for dogs in London. (Hat tip to Tyler Cowen.)

Comments (18)

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  1. Richard Walker says:

    One woman spent her $600 stimulus check on her three cats.  Another took a second job to pay for her pug's hip replacement.  (This is from an article in The Dallas Morning News.)

    Clearly, pet owners are choosing between pet care and other uses of time and money. The system works because people (and their furry friends) reap all the benefits and bear all the costs of their own decisions.

  2. Chris Ewin says:

    Great analogy…
    Physicians have had the same discussions with our patients…many times falling on deaf ears…

  3. Elan Rubinstein says:

    Regarding fee-for-service (FFS) pet care: Some people spend a great deal of money on their pet’s health. The difference between doing that and paying FFS for family health care is that when push-comes-to-shove and money becomes unavailable (due to loss of job, loss of house, or shifting priorities), the pet’s health care cost amounts to a luxury and is expendable, but the health of one’s spouse and children is neither. For example: If you had an “average” income, had you or a family member had a rare chronic condition the drug treatment of which costs thousands of dollars per month, and your cost share is 30% – 50%, what would you do to pay the bill, and what would you then think about FFS healthcare?

  4. Lin Zinser says:

    I have several friends and acquaintances who spend thousands of dollars to treat their pet’s physical and behavioral conditions, even using credit card debt to pay for the treatments. Contrary to Elan Rubenstein, these pet treatments (for some) are not expendable, but necessaries.

    A few of these same people balk at the thought of doing the same for their personal health care. They believe that their employer or the government should pay for “person health care.”

    In fact, all health care falls into the same categories as food, clothing and shelter — economic goods and services, and some people prize health above all else and some do not. Some are willing to mortgage their house and go into debt to pay for treatments and some are not willing to buy any insurance or to plan for the future. These are personal, moral decisions that each person and each family must make for themselves, and then be willing to live with the consequences.

    Without government intervention, the market can provide many varied resources to ensure that most people can afford medical services, and in America, history has shown that without government intervention, charity will take care of the rest.

  5. Ralph F. Weber says:

    In Canada humans sometimes see the vet for treatment, because they can get in. Vets earn more than MD’s, so usually they attract better people.

  6. D H Leavitt says:

    Thanks for such good clear and insightful thinking. I am going to share it with others, with credits to you.

  7. K. Pelletier, MD says:

    Good Morning John…

    Although I usually find your newsletter most informative… this one is really off the mark, at best!

    The one huge difference is that the rich are the only ones who can afford all that pet care but the poor cannot, just as in human care. No one discusses the suffering poor who cannot get care for themselves OR their pets because they are both living in poverty.

    In any case… just wanted to voice this concern.

  8. Elan Rubinstein says:

    A neighbor’s dog, weak & sickly for several years, was just diagnosed with lupus. The dog has been through several diagnostic workups and presumptive treatments, at great cost. The neighbor is paid 100% on a commission basis, and business has been down lately. He has 3 young kids for which he’s thinking of establishing & funding a 529 plan for college, but money is tight right now. Is it better that he put available funds toward the dog’s ongoing medical treatment or towards the kids’ college funds? This is a zero sum game – there is only so much money around to allocate, so one must have priorities.

  9. Nancy says:

    I need to comment on this. I have been in human medicine since 1974 (Physical therapist) and also have a veterinary technician license, I do part-time rehab on dogs. So I have lots of experience in both “worlds”
    First of all, there are many animals who are euthanised or left in shelters because owners can’t afford or don’t want to pay for their care.
    The facility I work at is a specialty surgery (mostly orthopedics) and 24-hour emergency /critical are hospital. Fees are high but less than a human hospital. There are 2 very well-equipped surgeries, digital x-rays a CAT scan machine and an MRI in a van which is shared with other hospitals. Of course animal hospitals don’t have unions and the pay scale is lower. A licensed vettech’s training is similar to a 2 years RN program , with the addtion of training in X-rays and lab work. There are advanced board certifications for Vet techs * not mandatory) in areas such as critical care and emergency nursing. However teh pay in the New York area is around $15-$18 an hour for a licensed vet tech. Un-licensed techs and vet assistants are paid much less.
    A total hip replacment for a dog where I work is about $ 7,000 which includes charges for basically what you see in a human hospital, only less. Cruciate repair for a knee runs in teh $3,000 range total. There are general practitioners who perform knee surgeries on dogs for less, maybe $1,700 range.
    Some of our clients have pet insurance, they generally pay only a portion and like “human” insurance, they often find reasons not to cover things. I think that pet insurance is most valuable for things such as Hit by Car, surgery to remove a foreign body, etc.

  10. Nancy says:

    I disagree with K. Pelletier. There are more health care options for poor people than “poor” pets ; emergency rooms have to treat humans regardless of ability to pay. I know from my work in human medicine, that here in New York we have multiple programs for reduced cost or even free health insurance for the poor, especially children or people with children. I have also seen many cases of parents not signing their children up for this low cost or free care despite advertising, etc. There is no Mecicare and Medicaid, Healthy New York, etc for pets. There are some lower cost veterinary clinics but they treat the more mundane problems. On the other hand , I personally know of a person with no insurance who had a total hip replacement plus 3 months of home care physical therapy for no cost whatsoever right here on Long Island, her hospital bill came to $80,000. Yes, they are applying for Medicaid which would pay most of this retroactively but it’s not a sure thing. Meanwhile I have worked for years for this major health care system, and since I am ” per diem employee ” , they refuse to let us pay into their health care coverage which is for salaried people only. So I pay for my own, which is now pretty measly coverage. I don’t belong to a group and am not considered self-employed. Add to that there is very little insurance carrier competitition in New York State for people in my position, the policies to choose from are very few. Hopefully when I make it to 65 in a few years, Medicare will cost less, it certainly gives more coverage than what I have now. McCain is the only candidate I have heard to mention the problem of health insurance for indivduals in New York, New Jersey and some other states. There are about 50 things that carriers have to include in a NY policy, so few of them will bother to make anything available in NY.

  11. Keith, RN says:

    This is a very rich and interesting discussion. Many salient points have been made, and there is much food for thought.

    Lin Zinser said, “without government intervention, the market can provide many varied resources to ensure that most people can afford medical services, and in America, history has shown that without government intervention, charity will take care of the rest.”

    I must take issue with that statement. How is charity taking care of the 47 million uninsured people in the U.S. today? Where are all of those uninsured people going for preventive healthcare? Who is caring for the 13 million uninsured children? Sure, they can be treated at an ER for acute issues, waiting for up to 8 hours to be seen. But they are not getting PAP smears, prostate exams, vaccinations, breast exams, mammos, scoliosis screenings, and colonoscopies at the ER.

    Zinser also says that some people will mortgage their house to pay for healthcare and others will choose not to. Is this really a moral decision, as the commenter suggests? What if that person has no house to mortgage? If they do mortgage the house, where will they live? How many Americans have been bankrupted by healthcare bills?

    There are many poor and uninsured people who receive no preventive care whatsoever, and society will eventually pay a higher price for their care in the end when they are disabled, stricken with chronic illness, and wards of the state. Covering everyone is expensive, yes, but the dollars spent on preventive care will save many more dollars in the future.

  12. Maybe Kramer Has a Point… | Atlas Network says:

    […] There’s a funny Seinfeld episode where Kramer seeks out care from a veteranarian because they’re obviously more talented than human-focused doctors (”I’ll take a vet over an M.D. any day. They gotta be able to cure a lizard, a chicken, a pig, a frog…”).    I’m not going to follow Kramer in making that radical a break with our medical system – but I have to say that I have been amazed to discover that my dog is cared for at a vet’s office that’s much better-run than my own doctor’s office.   Prompt, non-nonsense appointments, friendly staff, a clear payment system.    What a contrast from the “go sit in your underwear for 20 minutes staring at a wall” modus operandi at most doctor’s offices!   I bring this up, because John Goodman is speculating on his NCPA blog about whether our troubled health care system can learn anything from the pet care industry.  […]

  13. liz says:

    Very interesting blog. A few years ago, my Chow Chow broke her hip on the ice, I withdrew $2,500 from my 401k to pay for her surgery. I find that I tend to take my dogs to the vet A LOT more than I take myself to the doctor.

  14. beth says:

    This blog was forwarded to me by my mother, and I am a divorced mother of two. My children have insurance because they are covered by their father’s policy, but that’s the extent of it. I cover all their out-of-pocket expenses. At least they are covered.

    I have COBRA insurance which is $800 a month for only me and I have to pay 100% out of pocket until the $1500 deductible is met. I currently own a small business that doesn’t have enough employees to qualify for group insurance. Because I’ve had melanoma, I no longer look good on paper to insurance companies and cannot find a policy that I can afford.

    I haven’t had an income in two years so the COBRA is about to become a casulty of economics. I have three pets who do not go out in public as they haven’t had their shots in two years.

    It’s pretty scary to realize that routine medical care is no longer routine in my life and that I must now choose between gas in my car, food on my shelves, and medical care for me and the kids…forget the animals.

    Financially this is rock bottom for me. I don’t have a home to mortgage and have sunk all my assets but the car into my business. I’ve always been able to take my family – two and four legged – to whomever for the best medical care.

    They (the pets) are part of the family and they contribute to the emotional well being of all of us as we continue to try and survive this very bumpy ride. I repeatedly tell my children to take very good care of our four-footed friends. Taking them to the emergency animal hospital is no longer an option.

    When I received my college diploma and walked down the aisle with the “love of my life” I never dreamed that at 46 I would be income-less, non-insurable, and the sole responsible adult in the lives of my children.

  15. Robert Blandford says:

    Checkbook magazine in the Washington Metro area has gathered customer reviews of doctors, dentists, and vets.

    All are rated for quality. The dentists and vets are rated for price, but not the docs.

    The reason, presumably, is that Checkbook customers don’t have to worry about price for docs; insurance pays.

  16. John Sanderson says:

    Financing, decision-making, and moral/ethical value systems in Fee For Service (FFS) pet care and FFS human care are dramatically different.

    I am an advocate of the consumer-driven market and some elements of FFS as the best way to control human healthcare costs and describe how businesses can lead this movement in my book, “It’s All About Money: Winning the Healthcare War!” Although the consumer-driven aspects of the small animal veterinary business and the addition of more personal financial responsibility can work in human care, other differences abound.

    Pets may be highly valued and deemed worthy of large financial expenditures by their owner, but they are not as highly valued by society as a whole. Society expects hospitals, community clinics, etc. to serve as safety nets for human care while many animal shelters struggle to survive and must euthanize thousands of animals “dumped” on them because their owners either no longer want them or cannot afford to care for them. Several years ago my wife found an injured dog on the highway and took him to our own veterinarian. His response was, “If you will pay, I’ll take care of him. If not, I can’t do anything for him.” I also doubt that veterinarians’ malpractice insurance premiums or practice patterns are impacted as much by our overly litigious society as that of physicians rendering human care.

    Pet care is rationed based on financial resources just as human care is rationed in single-payer national healthcare programs in other countries. If a pet owner has the money, the animal gets the care. If the owner doesn’t have the money, the pet is euthanized or treatment is withheld until the pet dies. In some countries, delaying or withholding treatment may be deemed a socially acceptable form of euthanasia.

    Three of the biggest problems with the healthcare business in the USA are: 1) the absence of financial incentives for individuals to care about cost & consumption; 2) the absence of incentives to live healthy lifestyles; and 3) the absence of a transparent competitive model. Today, hospitals, physicians and other providers compete for network contracts by charging obscenely high prices to private pay patients and giving equally obscenely high discounts to networks and insurance companies. We should eliminate the unnecessary overhead of networks and force hospitals, physicians and other providers to compete for individual patients based on price, quality and service.

  17. Richard Green says:

    John, get a grip and “make it real.” Do you not see dogs run-over in the street and people just passing by?????

    Do you not know that thousands of mother dogs and their puppies starve-to-death every day???

    Maybe you should re-think your analogy.

    By the way —How much is that hound dog in the window???

    Did you know it is legal to purchase a casket individually now…. we would need a roving senior-pound to collect all the dead and de-composing bodies under your system.

  18. Jules Carney says:

    “Wow,” it is really nice to read a post from someone that knows a subject well and is able to get their point across. I am really looking forward to your next post.