The ‘Home Depot’ Approach to Medical Care Won’t Work
… How did it become normal, or for that matter even acceptable, to refer to medical patients as “consumers”? The relationship between patient and doctor used to be considered something special, almost sacred. Now politicians and supposed reformers talk about the act of receiving care as if it were no different from a commercial transaction, like buying a car — and their only complaint is that it isn’t commercial enough.What has gone wrong with us?
… Now, what House Republicans propose is that the government simply push the problem of rising health care costs on to seniors; that is, that we replace Medicare with vouchers that can be applied to private insurance, and that we count on seniors and insurance companies to work it out somehow. This, they claim, would be superior to expert review because it would open health care to the wonders of “consumer choice.”
What’s wrong with this idea (aside from the grossly inadequate value of the proposed vouchers)?
One answer is that it wouldn’t work. “Consumer-based” medicine has been a bust everywhere it has been tried. To take the most directly relevant example, Medicare Advantage, which was originally called Medicare + Choice, was supposed to save money; it ended up costing substantially more than traditional Medicare. America has the most “consumer-driven” health care system in the advanced world. It also has by far the highest costs yet provides a quality of care no better than far cheaper systems in other countries.
But the fact that Republicans are demanding that we literally stake our health, even our lives, on an already failed approach is only part of what’s wrong here. As I said earlier, there’s something terribly wrong with the whole notion of patients as “consumers” and health care as simply a financial transaction.
As you might expect, the libertarian right continues to preach the ‘medicine is just another commercial economic transaction‘ gospel (emphasis is mine):
I would also be curious to hear how most doctors serving the American public would feel about the idea that medicine shouldn’t be thought of as an economic transaction. Oh sure, it’s a specialized craft and the best docs build relationships with their patients. But I don’t see too many of them working for free.Here’s what I mean when I talk about medical consumers: Individuals making informed choices about the health services they want—and yes, that also means being informed about their cost. Krugman, of course, thinks this conception of medical markets is terrible because he thinks that when it comes to health care individuals either can’t or shouldn’t make those choices on their own.
Firefighters don’t work for free, either. Neither do police officers. Or the people who pave the streets, fill in the potholes, and build highways, bridges, or tunnels. But most people understand that fires, criminal acts, bridges, tunnels, and highways, are in a category that is fundamentally different in kind from computers, cars, and home entertainment centers. Most people understand, on an intuitive level, that a bargain basement sofa that turns out to be a piece of junk or cheap but crappy mobile phone service is fundamentally different in kind from a dangerous intersection with no traffic light. ‘You get what you pay for’ is just as true for health insurance policies as it is for used cars — but the consequences of choosing one that covers less because you cannot afford one that covers more are fundamentally different in kind from the consequences of buying a clunker car from someone on Craigslist. Those sentences I’ve bolded, above, are disingenuous and even orwellian. “Customers making informed choices about the health services they want” — patients can do that right now. As a recipient of Medicare, I can make informed choices about the health services I want based on medical necessity and quality, and I certainly know the cost as well, since I know how to read those “Explanation of Medical Benefits” that I always receive in the mail. The cry, “But if patients are consumers who know they have to pay the costs themselves, they will make wiser decisions about what is really necessary and what is not” is just doublespeak for “It’s not my problem if you can’t afford to see a doctor.” Some people actually say that out loud, and although they are wrong both morally and factually, at least they’re honest.
People certainly can make health care decisions on their own, and they certainly should and they certainly do — Krugman is saying those decisions should actually be based on quality and necessity, not affordability. Suderman, by contrast, is saying that if people cannot afford their health care, they should be on their own, but he tries to disguise that under the slimy bit of dishonesty of ‘Paul Krugman doesn’t think individuals are capable of making their own decisions and he doesn’t want them to.’ The truth is the reverse: Krugman does want individuals to make their own choices. Suderman simply doesn’t want the government to pay for those choices, whether they are medically appropriate or not.