Consumer-Driven Care: Boom, Bust, or Bouillabaisse?

Is Consumer-Driven Cure Just Another Bubble, or Is It An Important Piece of the Bigger Puzzle?

“There’s a huge boom going on in alternative renewable and new technologies, and it wouldn’t be happening without the bouillabaisse of incentives, mandates, subsidies, and the related group of ingredients.”

Daniel Gross, “With Help, Could Ethanol be the Next Internet? New York Times, quoting Daniel Yergin, chairman of Cambridge Energy Research Associates, May 27, 2007

I take my health care metaphors where I find them, even if I find them in the business section of the New York Times, and even they compare the alternative alcohol fuel boom to the Internet.

Why bouillabaisse as a health care metaphor? As Steve Martin, the American comedian, says, “Boy! Those French! They have a word for everything.” There’s got to be a word explaining what’s going on in American health care, and for me, Boullabaisse is it. It’s a French term for a rich soup made with fish, shellfish, vegetables, herbs, and saffron.

Boullabaisse is an apt metaphor for the rich soup of American health care. Our system mixes insurers, hospitals, academics, physicians, and consumers vying for control of health care. The soup is in a big bowl. And it’s rich. Health care consumes $2 trillion a year, bigger than the GNP of China.

At this point, consumer-driven health care is neither boom nor bust, but just a small part of the health system, part of the bouillabaisee. If you think of the system as a kettle of fish, consumer-driven care is a minnow, or perhaps a spice, adding flavor.

Influential people – Regina Herzlinger of Harvard Business School; Grace Marie Turner, president of the Galen Institute; and Greg Scandlen, head of Consumer for Health Choices – are pushing privately financed consumer-driven care as an alternative, in some cases, even a replacement, for the present system, now 47% paid for by government and 53% by the private sector.

On the other side are those who say health care is much too important to be left to the market, just as wars are too important to be left to generals. Sick people, consumer-critics assert, are too vulnerable, too subject to whims of unexpected illnesses, and too ill-informed to know what’s good for them . People, particularly the frail, elderly, the mentally ill, the poor, and the young can’t predict or control their health destinies, and therefore their care needs government subsidies, mandates, and oversight.

Proponents of market-driven forces like Rayola Dougher, senior economic analyst at the American Petroleum Institute, use this language,

“We think a reliance on market forces is the best way to satisfy any growing fuel requirement, and that any policies should reply a level playing field for all options. We just don’t think at this point that the government should pick winners or losers.”

“Alternative” as another word for “innovation.” I like to see alternatives played out in the market, rather than in the political arena, where these questions about cost and feasibility will be answered.

• Can the Medicare Drug benefit be fairly administered by competing drug companies and health plans? So far the answer is a qualified “Yes.”

• Will nurse-practitioner retail clinics satisfy a public need for convenience and lower costs enough to be in nail in the coffin of primary care? No one knows for sure, but I doubt it.


• Will baby-boomers embrace HSAs and high deductible plans enough to make them a force? Will they remain marginal. Will they cut costs sufficiently to ward off universal care enthusiasts? Or will politicians abort the consumer process by deciding for consumers?The answer is still up for grabs.

• Will large organized multispecialty groups replace independent physicians in solo practice or small groups? The answer thus far is a qualified “No.”

• Will physicians organize into groups or hospitals into systems providing integrated bundled care with predictable prices known in advance? Not yet, but it may be coming.

• Will the dream of a national system-wide information system linking all parties with ubiquitous EMRs and personal health cards ever become real? Or will it the dream become another burst economic bubble, like the dream of corporations like PhyCor and MedPartners, who thought they could organize doctors into corporate entities?

• Will the much touted chronic disease management industry, led by companies like American Healthways, transform health care for the elderly, cut costs, and improve outcomes? Many think so, and early evidence is promising. One thing is for sure. Given enough attention, the Hawthorne Effect, patients respond positively to preventive and wellness efforts.


• Will outbursts of market enthusiasm, and money spent on hype and promotion in hopes of economic and health gain, overcome the embedded problems inherent in an aging population.? Will this enthusiasm build enough public consciousness for taking care of yourself, looking for the best deals for choice and cost, spur consumer demand for make for a better and less costly health system? The jury is still out, but will render its decision within the next five years.

In a human endeavor as complex as health care, covering everything from soup to nuts, it’s important to cut through the clutter. It’s essential not only to seek the right answers, but to ask the right questions. Does this alternative, this option, this innovation address the concerns of people in their everyday lives? Does it fit their behavior? Does it offer convenience? Does it engage them? Does it speak to them in terms they understand?

Everything can be improved and sustained , if the right questions are asked and the right answers activated.