Patients Are Not Consumers
By PAUL KRUGMAN
Published: April 21, 2011
http://www.nytimes.com/2011/04/22/opinion/22krugman.html?_r=1&nl=todaysheadlines&emc=tha212
“But something else struck me as I looked at Republican arguments against the board, which hinge on the notion that what we really need to do, as the House budget proposal put it, is to “make government health care programs more responsive to consumer choice.”

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? “

“Before you start yelling about “rationing” and “death panels,” bear in mind that we’re not talking about limits on what health care you’re allowed to buy with your own (or your insurance company’s) money. We’re talking only about what will be paid for with taxpayers’ money. And the last time I looked at it, the Declaration of Independence didn’t declare that we had the right to life, liberty, and the all-expenses-paid pursuit of happiness.”

           

Patients don't behave as or respond like consumers.  Despite the shift to corporate medicine, driven by an infernal over-abundance of MBA graduates who believe otherwise, patients present with their own unique diseases and disorders, in various stages of illness, and then respond to treatment or fail to respond to treatment despite the best efforts of physicians; and despite the proclamations of MBA corporate officers.  

             Consumers sometimes know what they wish to purchase.  They have some control of the financial and property aspects of the purchase they initiate.  They can change their minds, choose another product, and decide to do without the item in question.  Patients have no choice in many cases.  They can't change environmental, physical, contagious, or genetic factors other than those factors that are behaviorally linked to their illnesses.  What they are diagnosed with is what they get at the door. There is no negotiation, no alternate diseases, and no second choices. 

            Patients walk in the door with the damage underway, unable to alter the realities of the situation.  Illnesses and injuries happen regardless of staffing, weather, convenience, and affordability.  They do not dance attendance to MBA business plans. 

            The GOPer/teavangelists who are intent upon dismantling Medicare are too young to recall how medicine was practiced before Medicare.  Seniors worked as long as possible, particularly if they had the rare job with health insurance benefits.  No insurance company wanted to insure seniors.  Seniors got sick or were injured.  They died quickly, or slowly, but mostly they died without benefit of long-term life-support.  Organ transplants were for the very wealthy and for patients on surgical teaching services.  Death was the outcome for far too many people with no means to pay for expensive and long-term care. 

            That is what will happen if the bastards succeed in dismantling Medicare.  The vaunted vouchers that are supposed to be handed out like promotional coupons at a fast-food shop will fall short of meeting the cost of health insurance for seniors.  Most of us will not reach retirement age without acquiring some disease or injury that makes us too expensive to insure.  The insurance companies will demand far more than Congress's MBA advisers and lobbyists will tell Congress it should cost to adequately insure a senior citizen.  The insurance companies will reap huge profits for writing policies that cover next to nothing.  Seniors will either deplete their savings to deal with health care costs, or will simply be unable to obtain care and will then die according to the teavangelist plan.  

            Patients are not consumers. 

            I agree with Krugman.  Not all health care costs should fall to the federal government.  Long-term life-support for patients unable to breathe and maintain circulation on their own should not be provided by Medicare.  We need to recall that sometimes the only certain outcome is death.  We need to return to the practice of hospice care for terminally ill patients who have no hope of recovery.  In addition, we need to stop over-utilization of high-end diagnostic equipment once a diagnosis is certain. 

            Patients are not consumers; physicians are not car-salesmen.  MBA's are not needed in the delivery of health care. 

            Perhaps it is time to treat Congress like the used-car salesmen so many of them seem best suited to be.  But I'll settle for treating them like poorly performing employees this year and suggest a national petition drive to introduce a bill making it impossible for Congress to set their own salaries and benefits.  We can begin by removing the automatic raise component that they designed to avoid having to publicly vote for their own raises. Yes, that's a good start