Yesterday's New York Times contained a very sensible column by Paul Krugman. He asks a question that’s really rather obvious – so obvious, in light of our national healthcare-funding woes, it’s escaped the attention of a great many who ought to be asking it:“Here's my question: 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?”
– Paul Krugman, “Patients are not Consumers,” New York Times, April 21, 2011.
This is more than a mere quality-of-life question. It’s got big implications for economics, as we continue to struggle through our national healthcare-funding debate:
“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.”
The problem is that there are an awful lot of people out there who profess an unquestioning, fundamentalist faith in what economist Adam Smith called, way back in 1759, “the invisible hand” of the market. For him, it was probably just a metaphor, but for his latter-day followers, it’s become a virtual deification of free enterprise. Attached to that invisible hand, in their fantastic imaginings, is a new Olympian god, who effortless regulates human affairs through astute transfers of capital.
That would be of little significance, were not living, breathing human beings mightily affected by such transfers.
That makes it, as Krugman correctly points out, a moral issue.
1 comment:
So true! I could agree with more Carl! Was part of a conversation at the health club today that, to me, illustrated the fundmental problem with treating us like consumer who will make choices. Here's the basic gist of what this person was saying - she has an PCP, oncologist and endocrinologist. She taking some medication for your condition (I am assuming a cancer of some kind,but don't know her well and didn't hear that part) and she's been have problems with the dosage or something. Anyway her endocrinologist prescribed certain adjustments. When she was at an appt with the PCP she informed him of this change. He launched into pressing for another course of treatment and indicating that she should choose. She thinking, "How can I choose, I am not the trained professional" She talks to the oncologist who agrees with her that the PCP and endocrinologist she be talking to each of the to compare notes. So here's my take away from this example upon seeing your blog when I got home. She was being treated like consumer by the PCP and endocrinologist...she chooses, not a patient who would coordinate care with the other doctors who are treating the patient.
Another point you make that struck me was that providing "choice" by going to the market to get your health insurance (like Medicare Advantage) only increases costs where the basic single payer systeme that Medicare is, maintain better cost control.
I go on, but as you know from my other comments on your blog, I have a lot opinions about this and I always like to encourage some sanity. Thanks for sharing Krugmans column. Hope your not just preaching to the converted.
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