Who Should Make Decisions About Your Health Care?
Certainly not you, at least according to the political left. Here is what Chris Jacobs has to say:
- Paul Krugman has taught me that “Patients are Not Consumers” and that “making [health care] decisions intelligently requires a vast amount of specialized knowledge”;
- The Center for American Progress, in making “The Case for Bureaucrats in Health Care,” has taught me that health care is different from buying shoes;
- Ezra Klein has taught me that “consumer-directed health care is a silly idea” because “patients are not qualified to evaluate good care”; and
- CMS Administrator Donald Berwick has taught me that “I cannot believe that the individual health care consumer can enforce through choice the proper configurations of a system as massive and complex as health care. That is for leaders to do.”
Full Chris Jacobs article here.
I find the divide between left-of-center and right-of-center public health advocates to be a vast expanse. Those on the Right want to empower patients by allowing them to control more of their own health care dollars. Those on the Left want patient-centered medical homes, where doctors make all the (correct) decisions.
Chris mentions many of the arguments from the Left. A concern I have is that doctors aren’t likely to respond to patient needs quite as emphatically if they are not geting paid for their efforts. Having patients control more of their own health care dollars is one way to accomplish this.
These people are all complete jerks.
This is a real rogue’s gallery.
Some of the arguments might apply better to high-tech, high-cost care where the costs of acquiring information are higher and there is less time to make a decision. But, it seems to me that general care is something most people should be able to coordinate on their own.
This is the editorial Greg Scandlen referred to in his comment on the previous post. It’s also up at the Daily Caller: http://dailycaller.com/2011/07/09/who-am-i-to-decide-how-my-own-health-care-should-be-handled/comment-page-1/#comment-531756
Granted there is an informational-asymmetry between the provider and patient in regards to medical knowledge, but the patient still holds autonomy and makes informed decisions. Even in emergency situations where the patient lacks decisional capacity, and an appropriate proxy is not available, physicians have implied consent that if the patient had the ability to choose they would want to receive emergency care….and only to the extent of emergency lifesaving interventions. Before any intervention, the provider must evaluate the patient for decisional capacity, or in essence evaluate the patient for the ability to understand their decisions. Patients may be price takers in this situation, but they still are consumers in regards to their health choices.
If one disregards or claims that patients are not consumers, or incapable of making rational decisions due to a lack of “specialized knowledge”, then by that line of reasoning one DOES NOT believe in the crux of medical ethics. Medical ethics is about maintaining patient autonomy and informed decisions. Yes, medical professionals are held to a higher standard and patients lack specialized medical knowledge, but Krugman’s argument suggests that medical professionals are omnipotent in regards to whatever ails us. That is not true, particularity with third party involvement. Without consumer choice healthcare you have a severe principle-agent problem, where patients are more vulnerable to an informational-asymmetry. History tells us patients need autonomy, and must be treated as consumers.
And to all the MBAs on Wall Street who took the nation down, I say I’d prefer to trust my own judgment. Paul Krugman, Donald Berwick, et al., insult our intelligence. I’ll stick with asking questions, doing my homework and playing an active – not passive – part in my health. In fact, I found this particularly helpful: http://whatstherealcost.org/video.php?post=five-questions