Economist Paul Krugman this week wrote a brief but thought-provoking New York Times blog post entitled “Patients are Not Consumers.”
With his usual eloquence (yes, I’m a fan), he demolishes discourse that equates patients with their pocket books: “The idea that all this can be reduced to money — that doctors are just people selling services to consumers of health care — is, well, sickening.”
To be sure, there are plenty of times that I’ve thought of myself as a consumer in the health care system and have acted accordingly. When a primary care doc’s front office staff was rude one too many times, I walked. When an obstetrician pooh-poohed questions about birth plans and c-section rates, I bolted.
I don’t even mind filling out those satisfaction surveys that the hospital sends after each endoscopy, especially if the people I’ve encountered have been especially helpful, or if something affecting comfort or convenience can be easily rectified.
That’s consumer behavior. When we are healthy, able, and, in situations where options do exist, then embracing our consumer prerogatives can make health care interactions less stressful and more satisfying.
But by playing up this familiar paradigm of consumerism—and by getting us to think of ourselves primarily as consumers—then those who stand to profit have the opportunity to divert attention from some disturbing corollaries.
For example: That the value of a patient lies primarily in his or her spending potential. That the sicker you are, the more valuable you are. That if you’re sick and have money, you’re more worthwhile than somebody equally sick but financially less well-off. That there’s not much profit to be made in keeping you well in the first place. That if there is little money to be made from your condition, then too bad.
This last ought to be of special concern to those of us with rare or unusual conditions, where our relatively paltry numbers don’t make a compelling economic case for massive research investment. (Yes, the NIH’s rare disease registry includes EoE and other EGIDs. And, no, I don’t mean to say that no research is underway; just that the forces of the consumer market will direct funding to more lucrative ailments.)
Perhaps you’ve experienced another downside of the consumerist paradigm if you’ve tried to get your insurance to pay for elemental formula or cover a specialist you need to consult. To say nothing about role of the doctor in this medical-consumer transaction. Do you really want your doc to be someone put in the position of selling you a service?
We are usually told that the open consumer market means more and better choices. But in the weird, unique market of health care, it’s the choices we have no part of and no access to that truly determine how well we are cared for.
Patients as consumers? Caveat emptor.