And my internist is not a “provider” of health care services. He is my doctor, and I am his patient. Yet politicians, economists, and policy wonks want to turn the intimate doctor-patient relationship into a simple economic transaction between a buyer (consumer) and seller (provider) of services.
Paul Krugman, himself a Nobel Prize winning columnist, writes about this in yesterday’s New York Times:
“How did it become normal” he asks, “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?”
Taking off on his theme, Krugman criticizes plans by House Republicans to “replace Medicare with vouchers” by arguing that “‘consumer-based’ medicine has been a bust everywhere it has been tried.” But not only does he think vouchers won’t work, he thinks, “there’s something terribly wrong with the whole notion of patients as ‘consumers’ and health care as simply a financial transaction.”
Now, let’s for a moment put aside Krugman’s political views and his specific criticism of the voucher proposal. (It isn’t just conservatives who refer to physicians as “providers” and patients as “consumers”—I did a search of how many times the words “providers” and “consumers” show up the Affordable Care Act, and found that “provider(s)” is used 620 times and consumer(s) 190 times, although the law also refers to patient(s) 603 times, and physicians 563 times.)
Doesn’t Krugman’s point resonate with you, regardless of your politics? Isn’t there something terribly wrong with medicine being taken over by the bean-counters and budget analysts who look at health care only as a transfer of economic goods from one person to another?
If a physician is just a provider, why should he or she be entitled to any greater respect or standing than a car salesman? If physicians are just a providers, who can blame physicians when they act like car salesmen, trying to maximize personal gain by selling more services to me, the consumer? If doctors are just “providers” aren’t we inviting the culture that Atul Gawande says he found in McAllen, Texas, “a medical community [that] came to treat patients the way subprime-mortgage lenders treated home buyers: as profit centers.” If physicians are just providers, what’s wrong with them providing more and earning a good living while doing it? And aren’t professionalism and ethics obsolete if medical care is nothing more than an economic transaction between the provider and the consumer?
We complain about doctors that are being squeezed to see more and more patients per hour—but if they are just providers, what is wrong with paying them based on how much care they provide each hour (otherwise known as productivity)?
If I am just a consumer, isn’t it my fault if something doesn’t quite go right with my health and I end up “consuming” more from the system than is my fair share? If I am a just a consumer, I am supposed to be able to shop around for a doctor, right? Just like I did for that new flat screen TV? But that’s not easily done when it’s a sick elderly parent who is admitted for emergency surgery, is it? Or you yourself are facing a frightening illness? Or if I don’t know who is a good doctor or a not-so-good one? And if I am just a consumer, isn’t it all my fault if I didn’t put aside thousands of dollars each year in case my mother might someday end up in a nursing home?
If we look at medical care simply as an economic transaction between “providers” and “consumers” then we shouldn’t be surprised if people act based principally on economic self-interest—the consumer getting as much as he can for as little cost as possible, and the provider earning as much as she can at the highest cost possible. Conservatives might try to alter the economic incentives by making the consumer accept more financial responsibility and letting insurance companies control the supply of services, and liberals might try to do it by having the government control the supply of services through price controls and limits on capacity. But either way, they are missing the point, which is that health care costs are ultimately the very personal and personalized decisions made by physicians and their patients in the examination room or bedside. We need to respect and support that relationship and help doctors and patients make good decisions together, rather than turning them into the equivalent of a used car salesman selling a lemon to a hapless consumer.
Today’s question: Do you agree that “there’s something terribly wrong with the whole notion of patients as ‘consumers’ and health care as simply a financial transaction?”