COMMENTARY

The American Healthcare "System" in 2005 -- Part 3: Why Not Put the Consumer in Charge?

Editor's Note:
American Health System Reform has returned to the front burner for 2007-2008. MedGenMed ran a sequence of Webcast Video Editorials in 2005 that tried to tell the whole story -- past, present, and proposed future -- in 7 easy lessons. It was well received then with high readership but the politics was cold. The situation in American healthcare has not changed fundamentally since 2005, except that conditions have worsened and a new presidential campaign is upon us. Ergo, the politics of health "system" problems is now hot. So, we are republishing all 7, in order, on sequential Thursdays. Read, enjoy, or get angry, but let us know what you think. Send us your reactions, proposals, serious health policy articles, letters, brickbats, essays, whatever. Help us boil the pot to inform the profession and the populace.

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Many Americans are pushing the concept of consumer-driven care.[1,2] Most healthcare already is self-care. So, why not empower consumers with good information so that they can take charge of their health? After all, it is their health! Why not let individuals make the purchasing decisions directly, spending their own money, so as to inject free-market components into the otherwise skewed medical marketplace? I like this idea as far as it goes, and I believe it is worth doing. But it contains fundamental flaws that prevent it from being a panacea. The medical marketplace is not a free one, nor could this movement convert it into one. Government, private insurers, and managed care companies set most payment rates; the required skill sets of practitioners are largely established by laws and regulations; and essential pharmaceutical products are often covered by patents, allowing prices to be set at whatever the market will bear. The consumer thus may have little actual bargaining power, even if forearmed with knowledge and highly motivated. Finally, our out-of-control cost escalation is driven mainly by high-tech interventions; surgery; emergency, critical, and intensive care; and chronic disease management. The great majority of total costs are expended on a small number of really sick people. So, let's push consumer-driven care, but not be deluded that we will fix our broken system by that approach.[3] That's my opinion. I'm Dr. George Lundberg, Editor of MedGenMed (to be continued).


Readers are encouraged to respond to the author at glundberg@medscape.net or to Paul Blumenthal, MD, Deputy Editor of MedGenMed, for the editor's eyes only or for possible publication via email: pblumen@stanford.edu

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