The Trouble with Consumerism

Economists speak of two essential premises for a “free market” to exist for a good or service. Among the purchasing options, (1) sellers must provide true choice (e.g., no supplier monopoly) and (2) buyers must possess information (with which to compare the attributes, performance, total cost, and reliability of each choice).


Seldom do those two conditions exist for an individual consumer of healthcare. Her employer has chosen the health plan. His hospital holds a geographic monopoly. Her doctor provides false choices (“We can do [my procedure] or you can continue to suffer.”). A surgeon’s post-operative infection rate or a consultant’s diagnostic accuracy rate is not available. 

Moreover, the majority of the healthcare dollars consumed in the US each year are the result of “acute” (sudden, urgent or emergent) illness or injury.  Can you imagine going through the steps to choose your hospital destination, as you are loaded into the ambulance following a pile-up on the interstate? 

patient preparing to be transfered after MVA

To their credit, American consumers increasingly seek comparative information, particularly on the Internet, but not all Internet content is accurate or applies to the circumstances at hand.  So by and large, individual consumers use lay (rather than medical) advice from friends or family, or “gut feel” to accept or decline a physician’s proposed course of action.

Real choice is coming in the form of Health Insurance Exchanges (HIX), provided for in the 2010 Accountable Care Act (“ObamaCare”). In such a virtual marketplace, individual Georgians will be able to choose Kaiser Permanente when previously that choice was withheld by their employer.

Under such circumstances, it’s best to have a doctor (1) paid to prevent and cure illness, rather than enriched by the magnitude of the patient’s misfortune, (2) judged and challendged by colleagues on the basis of measured quality outcomes, and (3) practicing in a fellowship of altruistically-minded colleagues. Welcome to Permanente medicine and surgery!

tspmg logo, with website Sept 2012

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