Patients aren't consumers
Everyone's talking about reforming the healthcare industry. President Bush is pushing high-deductible HSAs. There are books galore exploring the need for a new model. And the phrase on the lips of businessmen, insurers, and legislators alike is "consumer-driven healthcare." But every time I hear that phrase, it makes me mad.
Consumers have not been begging to shoulder more of the cost of their healthcare. And let's face it, that's what the movement is all about-saving money for the businesses that provide health insurance to their employees. But proponents don't put it so bluntly. They point to skyrocketing costs of medical care and claim that if people have to fork out more of their own money for that care, they'll use healthcare services more cost-effectively. Hogwash.
Healthcare services are not used by "consumers"; they're sought by patients-people who are sick. And people who are sick don't shop for a doctor or a drug or a test or even a hospital the way a consumer shops for a car or a dishwasher or a new pair of shoes.
The spinmeisters who are trying to convince the American people that "consumer-driven healthcare" will control healthcare costs are cut from the same cloth as those who brought us managed care, which saved money for a while, but didn't do anything to address the real issues that drive up the cost of healthcare-progress and fear.
No one would even suggest that we stop the research and marketing of real advances in the prevention and treatment of illness. No one wants to make the hard choices that would have to be made to ration those advances. And no one is doing much to address the cultural mindset and tort system that force every doctor to practice defensive-and costly-medicine.
Until we've figured out a way to rationally manage progress and fear, let's at least be honest enough to admit that we're just going back to a fee-for-service, patient-pays-first model because managed care didn't work, and quit trying to convince people that consumers-read patients-are driving anything in the healthcare arena.