Consumer-Driven Health Care
Without question, health care will be a major issue in the 2008 presidential election. Most polls rank it among the most important in the eyes of voters, including this Harris Poll (pdf) which suggests that it will influence 40% of voters. And though health care would be a major issue in its own right, Michael Moore’s forthcoming “documentary” on the subject, titled “Sicko,” will only raise its profile with voters. As Roger Friedman of Fox News wrote, “From the little we saw last night, it is clearly going to be a huge, huge hit…another cultural phenomenon.”
With so much attention being paid to the topic it’s important for poliy wonks like Indiana Barrister readers to be well-read on it. Ezra Klein, one of the leading lights of the leftist blogosphere, recently penned a post on the problems with consumer-driven health care, focusing in particular on the lack of knowledge and information that most patients have in evaluating health care:
Over in the Wall Street Journal, more empirical scorn is being heaped on consumer-drected health care, this time in the form of a study showing that consumers have absolutely no idea what good health care is. Researchers from the Rand Corp., UCLA, and Department of Veteran’s Affairs had 236 elderly patients in two major managed care plans rate the quality of their health care. Satisfaction was high, with the average rating a super 8.9.
Then the researchers sat down to rate the care these same patients received. They compared care received to care that should have been received, checking on fundamental metrics like whether a patient received aspirine within an hour of being diagnosed with acute myocardial infraction. Scores plummeted. Despite the high level of patient-satisfaction, the researchers gave the care a failing grade of 5.5. More interesting, the patients who rated their care as a 10 were just as likely to be getting low-quality care as those who reported a 5.
The problem? Patients are not qualified to evaluate good care. They’re qualified to evaluate whether the doctor was nice to them, whether he explained things clearly, whether the wait time was short and the experience pleasant. They do not know how well their care matched up to accepted standards of care, and they do not know whether the treatments they were given were comprehensive, well-targeted, or adeptly conducted.
The thrust of Klein’s argument, of course, is that we’re too stupid to handle our health care on our own. That philosophy is nothing new from the left. It is, after all, the basis of Social Security – you’re too stupid to plan for your own retirement.
The philosophy isn’t wholly without merit. I don’t know what procedures are necessary for a given symptom, and I’m not always well versed on costs. But there are rough analogies to work from. Cars are incredibly complex machines that I know very little about, yet the government doesn’t step in to make sure I’ve received good care. Similarly we rely on a privately hired inspector before purchasing a house. The obvious difference, of course, is that a shoddy car repair doesn’t always end your life; poor health care can.
Ultimately consumer-driven advocates must come up with an acceptible answer to Kelin’s argument, and it can’t involve involve complex economic theory. Otherwise Europe and Canada’s socialized health care system will come to the US to roost.
