I am a libertarian.
If I am not hurting anyone else I want to be left alone. At the core of this philosophy is the belief that I do not know what is best for you, and conversely neither you nor any external entity knows what’s best for me. This trips me up with conservatives who think the military or perhaps God knows what I need. It also separates me from liberals whose collectivist urges tend to gravitate towards more and bigger government.
But there are limitations to every philosophy, which shouldn’t surprise anyone. No idea is perfect and most are works in progress. No one says “Democracy is worthless because people don’t have time to make decisions about governing while raising families and holding down jobs.” Likewise I think that libertarian ideas such as “Do unto others…” should be followed until they no longer make sense.
For most of the past 2 decades I have witnessed the American medical system from the inside as the spouse of an American primary care physician. I’m the one who makes her a coffee and waves goodbye to her every morning, and I am the one who has dinner ready when she arrives home late at night after a long day at the office. I am the one who pays her medical school loans, cutting a mortgage-sized check every month that unfortunately fails to move the principle very much. During that time I estimate my wife has treated about 40,000 patients in a variety of settings, from poor inner city communities to wealthy boutique practices. She has even treated patients volunteering in rural communities in Africa.
Anyone who tells you they have a solution to the American health care system is frankly an idiot. The system is so big, so complicated, so riven with competing interests, contradictory regulations and demands that only here in America could we build such a huge, expensive, and f***ed up system. Our healthcare is such a disaster that it is hard to imagine anyone thinking it up from scratch. It combines the worst attributes of a single payer system with the dregs of capitalism to produce to produce the monstrosity we live with daily. No, such a system can only happen over a period of decades with the involvement of millions of decisionmakers.
And it is getting worse.
In the most recent attempt at cost-savings, patients are being asked to become consumers and are being tasked with shopping for health care in order to inject market forces into the system. This takes the process of say, buying a television, through comparison shopping and seeking the lowest price and attempts to squeeze visiting your doctor or a hospital stay into the paradigm. As David Shaywitz writing for Forbes notes, it won’t work. For one thing we are asking sick people with exhausting task of making decisions that are hard for healthy people to make. Think about the mental energy you put into a recent television or car purchase, then imagine doing that while sick. It’s unrealistic even for those of us who are relatively healthy, let alone for the 20% of the population who consume 80% of our healthcare. Take my late mother. It took my retired sister and her husband all their energy to make sure she received just the care she needed during all her bouts of pneumonia, her falls, and her failing kidneys. Now some expect them to have shopped around for the cheapest care on top of all. It’s not only unrealistic, it’s cruel. My sister spent the last few months with our mother in a constant state of stress and worry about providing my mother the care she needed instead of spending that time simply being with our mother.
Part of this “consumer driven health care approach” is the reliance upon customer feedback and surveys. Over the past year I have seen multiple doctors after almost killing myself in a dirt bike accident a year ago, and several times I have received emails and even robo-calls asking me to rate my doctor. There are several assumptions underpinning these surveys. First is the assumption that I have the knowledge necessary to grade him. My orthopedic surgeon has several medical degrees. I have a BA in political science. He has been doing surgeries for over 40 years. I have been working in IT for almost 20 years. He has performed thousands of surgeries like the two he performed on me. I can’t even carve a turkey without running to YouTube for instructions. To put another way, if your daughter needed a plate installed in her shoulder after a motorcycle accident, would you rather I did it or my doctor? If you answered the latter then why would you take my review of him seriously?
Next the consumer driven approach assumes that I know what I need. Say I need a new car because my old one broke down and I can’t get to work by public transportation. That’s a reasonable need that buying a new car fills, but even that comes with caveats. Why a new car? Why not a used one? What about a motorcycle or how about a bicycle? Patients walk into my wife’s office every day presenting with colds and demanding antibiotics. My wife examines them and diagnoses them with the common cold. She advises bed rest, symptomatic treatments like Ny-Quil, and explains that not only will an antibiotic not help them, it can cause severe side effects. My wife knows all about these first hand. She was prescribed a common antibiotic for the treatment of a minor infection and lost her sense of smell for almost 2 years. But she has faced irate “clients” (the word the corporation she works for advises doctors to use when referring to their patients) who will not leave unless they get what they want.
Doctors in this position face a predicament. Do they satisfy the patient by prescribing him or her drugs they don’t need, or do they risk complaints being lodged with the companies they work for, or on websites that grade doctors? These comments and complaints have been used by health care systems to deny their doctors raises and in some cases limiting advancement and even the renewal of their contracts. This stress is one of the factors behind physician burnout that drives doctors out of clinical practice, exacerbating the physician shortage.
Going to the doctor or hospital is not like buying something at Amazon or Ebay, and we shouldn’t fool ourselves into thinking that it is.
(to be continued)