"Patients Are Not Consumers"

[Frank Nutter]

http://www.nytimes.com/2011/04/22/opinion/22krugman.html

Medical care, after all, is an area in which crucial decisions — life and death decisions — must be made. Yet making such decisions intelligently requires a vast amount of specialized knowledge. Furthermore, those decisions often must be made under conditions in which the patient is incapacitated, under severe stress, or needs action immediately, with no time for discussion, let alone comparison shopping.

That’s why we have medical ethics. That’s why doctors have traditionally both been viewed as something special and been expected to behave according to higher standards than the average professional. There’s a reason we have TV series about heroic doctors, while we don’t have TV series about heroic middle managers.

The idea that all this can be reduced to money — that doctors are just “providers” selling services to health care “consumers” — is, well, sickening. And the prevalence of this kind of language is a sign that something has gone very wrong not just with this discussion, but with our society’s values.

Discuss.

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[Dr Oops]

I agree.

The point of a business is to sell customers things to make money.

The point of a patient going to a doctor is to better their health.

If society is going to force doctors to become business men, then they will pay the price for that mistake.

 

[siliso]

Wholeheartedly agree.

 

[hawkeye pierce]

I think they are consumers currently. That is the problem with our non socialized programs. If people could be treated without respect to ability to pay then our health system would instantly improve.

 

[VA Hopeful Dr]

I think they are consumers currently. That is the problem with our non socialized programs. If people could be treated without respect to ability to pay then our health system would instantly improve.

They can be. EDs, government sponsored clinics, free clinics, doctors who operate with sliding scale payments all exist for just this reason.

Its not perfect, but patients can get care even if they can't afford it.

 

[VoiceofReason]

citizens of a capitalist society deserve everything they get and worse

 

[motomed]

The point of a patient going to a doctor is to better their health.

so why can't better health be the product? I bet those of us with some medical knowledge approach our healthcare decisions almost entirely as consumers.

 

[JKinSC]

I posted this elsewhere (I believe in the Lounge), but I'll post it again, as I think it's the best response I've seen to Krugman's essay:

http://www.economist.com/blogs/democracyinamerica/2011/04/sacred_and_profane

And two of my favorite quotes from it:

If the deep worry about certain forms of market exchange is that they put the poor at a disadvantage, we can address the worry by making certain that means-tested transfers are generous enough to ensure sufficient market power for all. But we can’t address concerns about market inequity in this way if market-based policy is preemptively ruled out of bounds by a misguided public theology of markets and politics.

The policies that publicly express good will and mutual respect—that successfully broadcast that we care about one another—often are not the policies that would actually deliver the goods—the policies you’d favour if you cared more about people than signaling that you care about people.

 

[Slack3r]

I posted this elsewhere (I believe in the Lounge), but I'll post it again, as I think it's the best response I've seen to Krugman's essay:

http://www.economist.com/blogs/democracyinamerica/2011/04/sacred_and_profane

And two of my favorite quotes from it:

I don't care much for the Economist usually, but that's an excellent essay!

I particularly liked this one:

What has gone wrong with this celebrated economist such that he has come to believe that something "has gone wrong with us" if we have come to conceive of those who buy medical services from those who sell them as "consumers", which is what they are?

And this:

I'm sceptical of the idea that the business of "receiving care" is now more commercial than ever. As many economists are glad to tell you, the astronomical American level of health-care spending is largely a function of "price insulation"—of the fact that, um, "care receivers" are, by dint of the nature of typical health plans, prevented from taking costs much into account. We have arrived at our present unsustainable situation because we have moved health care into a liminal zone away from the market discipline of the cash nexus, but not all the way toward the bureaucratic discipline of socialism, such as it is.

 

[pingouin]

Moving to Topics in Healthcare for further discussion.

 

[Marcus Brody]

The idea sounds good because it is consistent with the way the system currently works. We use copyrights, patents, licenses, and taxes and regulations to drive education and training of physicians, so it only makes sense that we do the same for patients, right? We protect the entire community of providers but not the consumers, so people like Krugman just want to correct the double standard.

The problem is that two wrongs don't make a right. The primary wrong is all of the licenses and restrictions, drug and device patents, care mandates and other various regulations, that drive up income for providers and prices for the consumers. These laws don't just explain all the problems we have, they're also fundamentally unethical.

For example, there is nothing ethical about criminalizing charity, which is exactly one of the things they've done. Do you know how difficult it is to set up a charity clinic, how much red tape, applications, fees, approvals, certifications there are just to help people? Provide any meaningful help to people and you will get shut down or sued or fined. Basically, competition is criminalized. You are allowed to compete only within the profession, no one is allowed to compete with the profession itself. This is the true restriction on access. When you look at it, it is actually like a criminal racket...

But that's how it already is, Krugman doesn't want to solve that, he wants to double down- restrict not only who can provide health care, but also who can receive it. Whether he admits it or not that is an absolute requirement if you aren't treating patients as consumers, because in order to make care "affordable for everyone" prices have to be controlled. Anyone trying to get around the price controls, ie paying higher prices for better private service, would be a criminal.

So in this world, charity would be criminalized on one hand, while mutual exchange is criminalized on the other. This is all pretty f*cked up if you think about it.

 

[I'm No Superman]

Correct me if I'm wrong (which I very well may be), but if patients aren't consumers, then we have to assume that people buying food, clothing, and shelter are not consumers. Therefore, we need a government take over of healthcare, the housing market, the food industry, and the clothing industry to make sure that no one gets "screwed" out of their money. You know what? Why don't they just run everything.

Yay Communism!

 

[shaggy alfresco]

That's like saying since you don't pay for private mercenaries to protect you and instead rely on police and/or army (e.g the big bag gubbment) for those services (hey! you're not a consumer), you really are a communist and you should just be in favor of state control of every single industry.

Not really no, it's not a logical progression. For one, because unlike with food, you're not really a 'consumer' when you have a heart attack at 2AM, nor are you probably in an appropriate state of mind to decide on your treatment options if you've been told you have cancer and some quack is telling you 'But in Bolivia, we have this new trial for $50,000.....'

The situations are not analogous. And anyway, thousands of people don't starve to death in the US like they die for lack of medical care.

 

[I'm No Superman]

Just wanted to clarify that my previous post was a joke, and I don't truly believe 100% of what I wrote.

I do agree with you on most of what you said, specifically about doctors who take advantage of patients who are not in the right state of mind to make financial decisions.

 

[Stitch]

Not really no, it's not a logical progression. For one, because unlike with food, you're not really a 'consumer' when you have a heart attack at 2AM, nor are you probably in an appropriate state of mind to decide on your treatment options if you've been told you have cancer and some quack is telling you 'But in Bolivia, we have this new trial for $50,000.....'

The situations are not analogous. And anyway, thousands of people don't starve to death in the US like they die for lack of medical care.

So if you are not consuming health care after your heart attack, what are you doing exactly? Healthcare is a limited resource, and understanding how patients consume it is important. In America, patients want every test done and want 100% accuracy. In most European countries they understand that this isn't possible. But both groups consume healthcare.

Let's not equate consumers with customers. They aren't the same thing. I would agree that patients are not customers, though many admins are beginning to see it that way.

And 'thousands' of people don't die for lack of healthcare. That's one of those political lies that gets thrown around to make drama. People get healthcare. The issue is often that they go bankrupt trying to pay for it. Or the hospital does.

 

[shaggy alfresco]

So if you are not consuming health care after your heart attack, what are you doing exactly?

No, I meant consumer as in being of rational mind and choosing your provider. You can't search through the books and get quotes for the cheapest hospital that's willing to take care of you when you're having that heart attack.

Let's not equate consumers with customers. They aren't the same thing. I would agree that patients are not customers, though many admins are beginning to see it that way.

Yes, I agree.

 

[Slack3r]

No, I meant consumer as in being of rational mind and choosing your provider. You can't search through the books and get quotes for the cheapest hospital that's willing to take care of you when you're having that heart attack.

The definition of "consumer" is one who uses goods or services. It has nothing to do with "shopping around".

 

[siliso]

It only makes a difference when you start trying to make healthcare policy that is based on people being rational and informed economic actors who can look out for their own interests, as though the same policy that works for buying and selling "consumer goods" can apply to health care.

 

[AntiHouseMD]

The problem is that we're willing to sacrifice our health for money. Some schools won't choose healthy options because it'll cost too much money. Patients are sometimes denied crucial medical care because it isn't covered by their insurance. We have to acknowledge that some things come before profits, including our health. Sadly, people sometimes need to "shop around" because they have no other options. The current health-care system is screwed up, and we need to get away from the "business" side of medicine. I understand that providers and executives need business skills to earn a decent profit that allows them to have a livable salary, but I can't agree with executives willing to sacrifice the health of the general population to simply add onto their already high profits.

 

[GH253]

Strongly disagree with Krugman. His intention is to justify the subjugation of doctors to advance socialized medicine. That's all this is about.

 

[themule]

Patients are sometimes denied crucial medical care because it isn't covered by their insurance.

Got an example of this? If it's crucial that usually means medically necessary and the proper care is given regardless of ability to pay.

We have to acknowledge that some things come before profits, including our health.

Why?

Sadly, people sometimes need to "shop around" because they have no other options.

Why is this wrong? Seems to me that finding the most bang for your buck is being an informed consumer.

The current health-care system is screwed up, and we need to get away from the "business" side of medicine.

What exactly is the "business" side of medicine? Is it the part that has to earn enough money to pay the salaries of the employees? The part that has to pay for the overhead on your clinic?

I understand that providers and executives need business skills to earn a decent profit that allows them to have a livable salary, but I can't agree with executives willing to sacrifice the health of the general population to simply add onto their already high profits.

Who has sacrificed the health of the general population for their own greed? McDonalds? The Corn Growers Association? The folks that make that Devil Rum?