No Consumers, Only Patients
Coming back to the bit of health care psychosis explored the other day, the article entitled: "Consumers Will Choose Safer Hospitals 97% of the Time, Regardless of Cost" is really a tour de force in wrong-think. The title seems to write the article. Based on that title, wouldn't you just thing "well, duh!" But it all goes spectacularly wrong from there. Because the title is actually very wrong - and very political.
People who receive medical care are "patients." They are not "consumers."
All humans are, at some level, consumers. We eat, we drink, we breathe. We 'consume' food water, air, and other things that are treated as commodities in the world today. But that does not make us 'consumers' in the sense that is meant by this ideology.
In this market philosophy, a 'consumer' is someone who uses money to purchase consumable goods. Penniless refugees certainly 'consume' food water and air, but are not Consumers because they have no market power, and therefore no market value. A Consumer in this ideology is someone with an impact on the market. Wealthy Consumers are attractive to industries because they have more money to spend. Poor Consumers count next to nothing and have no influence on the market, aside form the power of a deep discounter to push all their pennies and nickels into a big enough pile to make themselves wealthy.
So Consumers make purchasing choices that influence business, and business does stuff like advertising to change Consumer selections. So far so good.
This all falls apart when human health care comes to be treated as a Consumer good, selected like a Volvo or a box of Lucky Charms. People have no opportunity or capability to 'shop' for health care. Aside from choosing the ACA coverage that fits the family budget and current health needs, personal care decisions are not a marketplace. When a doctor says you need a medication, you do whatever you can to get it.
When a doctor says your kid needs an operation, within the bounds of getting a second opinion, you will do anything to get that operation done.
You and your kid are not Consumers. You are not going to seek a cheaper alternative - a cut-rate doctor. It's not an occasion to go shopping. The price only matters when you can't afford it - which was true for millions of Americans before ACA. It doesn't matter for the civilized world outside of the US where universal health care is a human right.
Price is a factor in the system, but only after the health outcomes are taken care of - not before. The US system is still a desperate greedy morass because the profit motive remains the driving force, well before the lives of patients. So, in the American formulation, 'let the buyer beware.' Get your money right, or don't get sick.
So, the study that shows 97% of people don't care the first damn about costs should prove to everyone who knows what a 'percentage' is that people don't care what medicine costs. It's not a 'market' full of 'Consumers' when everybody wants to be healed no matter the cost. How can it be a "market" when nobody cares about cost? Who are you negotiating with???
But this just proves Upton Sinclair right for all occasions: “It is difficult to get a man to understand something, when his salary depends on his not understanding it.”
According to the article" “These results indicate that consumers are well equipped to assess the tradeoffs of price and safety,” said Wendy Lynch, director of CCCHC."
Sorry: tradeoffs? TRADEOFFS? The results indicate that people don't want any "tradeoffs." People want to have good care, period. Nobody is willing to trade price for safety.
Sadly, it get worse: “It’s wonderful to see the data reinforce the value of the Hospital Safety Score,” said Leah Binder, president and CEO of The Leapfrog Group. “If you give the consumers a simple, understandable metric about safety, consumers are fully capable of making their own, informed choices about where to get their care.”
That's a staggering misreading of these results.
Patients are not Consumers. They can't make informed choices - they can't debate their doctors about the care they need. However much money they pay for care, they can't intelligently evaluate the diagnosis of one doctor against another.
The Leapfrog Group does the nation a great service by gathering and reporting hospital safety scores, which have been closely hidden in the past. But the purpose of these scores is not and should not be intended to aid a shopping trip. The value is in forcing worse hospitals to get better.
Are we expecting the market to fix the worse hospitals by having people try to choose better hospitals and therefore have the market drive them out of business? How big does the body count have to be before the invisible hand makes a fist and crushes the place?
What about the unfortunate rich people who are taken to a poor hospital because they're having a heart attack? They're wealthy! Why should they suffer??
We can't let Consumers suffer and die because we're expecting the market to fix a system that it doesn't influence in the first place. If a hospital (or clinic, or doctor) is shown to be substandard, it needs to be fixed, not driven out of business by competition. Health care, by its nature, is non-competitive. If you were given the choice of getting better care if someone else got worse care, if you're human you don't play that game.
So why are we encouraging the system to play the game?
Market function by having winners and losers. Do we really want to build a health care system predicated on the belief that there will be 'health care system losers"' Are those people acceptable losses for a market system?
Even if you're a Rightist Social Darwinian and think that the poors are lazy and deserve their poverty, at least realize that their kids didn't have a choice. The babies aren't inherently lazy, are they? If you're joining Ted Cruz on that road to racism, please don't drag the rest of the country down into that ugly pit with you.
If you offered a choice between drinking a glass of clean water vs. drinking a glass of Drain-O, would the cost be a factor? What if I told you the Drain-O was half the price of the water? Would you be interested? What is the price point that makes the Drain-O option more attractive?
Right - there is no price. It's not an economic question.
People who receive medical care are "patients." They are not "consumers."
All humans are, at some level, consumers. We eat, we drink, we breathe. We 'consume' food water, air, and other things that are treated as commodities in the world today. But that does not make us 'consumers' in the sense that is meant by this ideology.
In this market philosophy, a 'consumer' is someone who uses money to purchase consumable goods. Penniless refugees certainly 'consume' food water and air, but are not Consumers because they have no market power, and therefore no market value. A Consumer in this ideology is someone with an impact on the market. Wealthy Consumers are attractive to industries because they have more money to spend. Poor Consumers count next to nothing and have no influence on the market, aside form the power of a deep discounter to push all their pennies and nickels into a big enough pile to make themselves wealthy.
So Consumers make purchasing choices that influence business, and business does stuff like advertising to change Consumer selections. So far so good.
This all falls apart when human health care comes to be treated as a Consumer good, selected like a Volvo or a box of Lucky Charms. People have no opportunity or capability to 'shop' for health care. Aside from choosing the ACA coverage that fits the family budget and current health needs, personal care decisions are not a marketplace. When a doctor says you need a medication, you do whatever you can to get it.
When a doctor says your kid needs an operation, within the bounds of getting a second opinion, you will do anything to get that operation done.
You and your kid are not Consumers. You are not going to seek a cheaper alternative - a cut-rate doctor. It's not an occasion to go shopping. The price only matters when you can't afford it - which was true for millions of Americans before ACA. It doesn't matter for the civilized world outside of the US where universal health care is a human right.
Price is a factor in the system, but only after the health outcomes are taken care of - not before. The US system is still a desperate greedy morass because the profit motive remains the driving force, well before the lives of patients. So, in the American formulation, 'let the buyer beware.' Get your money right, or don't get sick.
So, the study that shows 97% of people don't care the first damn about costs should prove to everyone who knows what a 'percentage' is that people don't care what medicine costs. It's not a 'market' full of 'Consumers' when everybody wants to be healed no matter the cost. How can it be a "market" when nobody cares about cost? Who are you negotiating with???
But this just proves Upton Sinclair right for all occasions: “It is difficult to get a man to understand something, when his salary depends on his not understanding it.”
According to the article" “These results indicate that consumers are well equipped to assess the tradeoffs of price and safety,” said Wendy Lynch, director of CCCHC."
Sorry: tradeoffs? TRADEOFFS? The results indicate that people don't want any "tradeoffs." People want to have good care, period. Nobody is willing to trade price for safety.
Sadly, it get worse: “It’s wonderful to see the data reinforce the value of the Hospital Safety Score,” said Leah Binder, president and CEO of The Leapfrog Group. “If you give the consumers a simple, understandable metric about safety, consumers are fully capable of making their own, informed choices about where to get their care.”
That's a staggering misreading of these results.
Patients are not Consumers. They can't make informed choices - they can't debate their doctors about the care they need. However much money they pay for care, they can't intelligently evaluate the diagnosis of one doctor against another.
The Leapfrog Group does the nation a great service by gathering and reporting hospital safety scores, which have been closely hidden in the past. But the purpose of these scores is not and should not be intended to aid a shopping trip. The value is in forcing worse hospitals to get better.
Are we expecting the market to fix the worse hospitals by having people try to choose better hospitals and therefore have the market drive them out of business? How big does the body count have to be before the invisible hand makes a fist and crushes the place?
What about the unfortunate rich people who are taken to a poor hospital because they're having a heart attack? They're wealthy! Why should they suffer??
We can't let Consumers suffer and die because we're expecting the market to fix a system that it doesn't influence in the first place. If a hospital (or clinic, or doctor) is shown to be substandard, it needs to be fixed, not driven out of business by competition. Health care, by its nature, is non-competitive. If you were given the choice of getting better care if someone else got worse care, if you're human you don't play that game.
So why are we encouraging the system to play the game?
Market function by having winners and losers. Do we really want to build a health care system predicated on the belief that there will be 'health care system losers"' Are those people acceptable losses for a market system?
Even if you're a Rightist Social Darwinian and think that the poors are lazy and deserve their poverty, at least realize that their kids didn't have a choice. The babies aren't inherently lazy, are they? If you're joining Ted Cruz on that road to racism, please don't drag the rest of the country down into that ugly pit with you.
If you offered a choice between drinking a glass of clean water vs. drinking a glass of Drain-O, would the cost be a factor? What if I told you the Drain-O was half the price of the water? Would you be interested? What is the price point that makes the Drain-O option more attractive?
Right - there is no price. It's not an economic question.
posted by fiduciary at 10:37 AM
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