Consumer-driven Healthcare

President Bush thinks purchasing health care is no different than buying a car. He says that if I shop around for my medical care the same way I did for my Honda Accord, the price of health care will go down.

Bush said the current system, in which employers and insurance companies are the most involved in paying health care bills, makes individuals less engaged in the cost of the procedures they get.

"When somebody else pays the bills, rarely do you ask price or ask the cost of something," the president said during a panel discussion on his health care initiatives at the Department of Health and Human Services. "The problem with that is that there's no kind of market force, there's no consumer advocacy for reasonable price when somebody else pays the bills. One of the reasons why we're having inflation in health care is because there is no sense of market."

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"When you go buy a car you're able to shop and compare," he said. "And yet in health care that's just not happening in America today."

This is Bush's big plan to solve our nation's health care crisis. He wants medical patients to haggle over price at the doctor's office the same way they do at Diamond Joe's Pre-owned Imports.

How can the average person, and by "average" I mean anyone without a medical education, weigh the relative merits of health care products the same way they do for cars? Which health-care products are we supposed to shop around for? Medications? Operations? Tests?

If the Honda salesman tells me I need leather seats instead of cloth, I can make a decision based on several easily understood factors: whether I want to pay the extra 12-hundred bucks; whether the back-end resale value is worth the upfront expense; and whether I want the backs of my thighs to fry when I get into my car on a hot, summer day. It is easy to conduct a spot cost/benefit analysis when it comes to cloth seats versus leather.

If my doctor tells me she needs to run a PSA test to determine if I have prostate cancer, I have no frame of reference even to question her about it. I can ask her if it is necessary. If she says "yes," I have no follow-up. I want to know if I have cancer. If she tells me that I need the test, I'm going to get the test.

I am also unlikely to argue with her if she tells me I need medication to treat high blood pressure or surgery to remove a tumor from my lung. I can get a second opinion, certainly. But, the doctor is the doctor. I trust her to know more about these things than I do. The free marketeers will argue that as the consumer, it is my reponsibility to educate myself. Well, I suppose I could find a few extra minutes per day to scan WebMD.com, but I don't have the time to go to medical school.

And, what does it mean to "shop around" for health care in the first place? Does the president expect me to drive all over town looking for the hospital with the cheapest MRI rates the same way I look for the supermarket with the least expensive milk?

Of course, this is the problem with even accepting Bush's framing of the issue. He wants the people known now as "patients" to become identified as "consumers." A patient is someone who is under the care of a doctor. A health care consumer is someone who is purchasing a service. Bush would have us believe that there is no difference between seeing a cardiologist about chest pains and visiting a mechanic for a new muffler.