Krugman’s Blinders

By Greg Scandlen

There has been a lot written about Paul Krugman’s recent op-eds  and blog posts about how thinking of people as “consumers” rather than “patients” violates their “sacred” relationship with doctors.  My colleague Ben Domenech had one of the best rebuttals in Consumer Power Report #269.

It is more than a little disconcerting to hear people like Paul Krugman suddenly invoke the sacred doctor/patient relationship when they have been working so hard to have bureaucrats control both physicians and patients. But I want to make a different point, one that has been lacking in most of the commentary.

The whole point of Consumer Driven Health Care is to get people involved in their health care decisions long before they become patients.  For decades the “health policy community” has been fretting over this very thing – how to improve “health literacy,” how to get people to make healthy lifestyle choices, how to get people to ask questions about their treatment alternatives, how to teach people when it is appropriate to rush to the Emergency Department and when it is not, how to teach people the differences between the various medical specialties, etc., etc., etc.

We have health education classes in high school. We have newsletters with “Tips for Healthful Living.”  We have media reports about the latest breakthroughs in prevention and treatment.

None of it worked very well – until the advent of Consumer Driven Health Care. Suddenly people are responsible for making decisions about how to spend their own money for their own health, and they demand more information about their options. They sit together in the kitchen to decide how much money to set aside in a saving account and how big a deductible they can handle.  They have discussions about how often the kids go to the doctor and whether they will need glasses or dental work in the coming year. They look for lower cost generic drugs to replace the name brands they have been using. They use home remedies first, before making an appointment with the doctor. They participate in wellness programs.

They are not yet “patients.” They are active “consumers.”

If the Krugman’s of the world would take off their political blinders, they would see something wonderful is happening in the market.  But that would shatter their illusion of an all-powerful bureaucracy fixing everybody’s problems.

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4 Responses

  1. Lets accept the point that consumer decision making has no role in life-and-death circumstances, like when the tension-building music comes up on “ER” or “House.” What Krugman fails to acknowledge, and even most consumerism proponents don’t realize, is that today’s HSA compatible plans provide patients and their families MORE FINANCIAL PROTECTION than ACO/HMOs. (I’m just going to call them MACHOs from now on; Greg will figure out what it stands for.). The reason is the out-of-pocket maximum. BY LAW, an HSA-compatible plan must cover your expenses 100% after the OOP max is hit. There are no such requirements for MACHOs. (Catchy, isn’t it?) Further, even if you are too “disadvantaged” to have saved a dime in an HSA, you can run the OOP through an HSA and save 20% – 40% through taxes.

    It’s just drivel to characterize the consumerism position as advocating that people in life-or-death situations shop around on the way to the ER. Although it is worth pointing out that when we have more consumerism, ERs may be far better at handling real emergencies because they won’t be clogged up with people who don’t need to be there.

  2. Also, consumers may figure out in advance which hospital/ER is most cost-effective and let everyone know where to go if possible. Insurance companies are also beginning to reward their policy holders for such choices, e.g. with differing co-pays.

  3. Paul Krugman is one of the most dishonest “intellectuals” out there.

    For example I cringed when I read this comment in connection with whether the government should be able to control costs:

    “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”

    The perversity of citing this section of the Declaration within the context of discussing government control of health care is just mind-boggling.

    Then he cites Medicare + Choice as an example of having tried market approaches!!

    Let’s tell it like it is: Krugman is against people making rational choices about their own lives, because that’s what being a consumer really is. He calls this “sickening”.

    At least we know where he stands and how much respect he really has for people.

  4. Paul Krugman’s article appeared 4/22. My response (on line) is #296. Too long to post here, but I point out the patient is a “consumer” of INSURANCE coverage, not medicine; that doctors have little say in coverage; that the pay from Medicare is pitiful; that we have already for years been losing many of the best and brightest who wisely will not choose medicine for a career; and that, as so often, Krugman doesn’t know diddly about which he writes.

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