Wednesday, June 11, 2014

Consumers Know Best about Health Care

Government may think it knoweth,

What is best for most of us.

But the market often bestoweth

What is good for the rest of us.

Richard Reece,  The Health Reform Maze (Greenbranch Publishing, 2010)

A foolish consistency is the hobglobin of small minds.

Ralph Waldo Emerson (1803-1882),  Self-Reliance

I have consistently maintained that consumer-driven health care, not  government controlled and  dictated health care,  is key  to lowering costs,  raising quality, and satisfying the populace.

Am I wrong?  Is my consistency the hobglobin of a small mind that the collective marketplace of individuals seeking freedom and choice  possesses more wisdom than any collection of government experts who believe they possess some sort of elitist wisdom that transcends the minds of ordinary mortals.

Who knows best what to do when it comes to health care?

Government experts?  Government experts armed with computer data on outcomes?  Government experts judging doctors’ performances?   Government experts putting all health care within the context of a national health care policy?   Govemment experts controlling prices, guiding care, and directing patients to doctors  of whom government approves?  Government experts functioning as mandate mandarins?

Or is it remotely possible that health care consumers and patients know best?   Is it conceivable that patients on the ground spending more time listening to doctors and doctors  spending more time listening to patients know best what is good for the both of them?   Is it realistic  to suppose that the collective wisdom of the people, deciding what health care to get at the marketplace level might know what is best for them in their individual circumstances?  Was James Surowieki right when he wrote,  The Wisdom of Crowds: Why Many Are Smarter Than the Few and How Collective Wisdom Shapes Business, Economics, Societies, and Nations?

Is consumer-driven bottom-up care preferable or inferior to top-down dictated are?   What should be the balance between the two?    

These questions will never be answered to the satisfaction of all, for the answers rest on your ideology whether government or the people should rule, and whether government set the standards by which we live?

According to the most  recent June Fox News poll, conducted jointly by Democratic and Repulicaan companies, people of all political stripes are unhappy with ObamaCare: 53% wish it had never passed; only 31% think ObamaCare would do a better job than the VA; 44% say they are worse off than before the law passed; and 58% disapprove of the law.

Stephen Parente, director of the Medicare Industry  Institute at the University of Minnesota, says ObamaCare will ultimately fail because it will not deliver on its twin missions of reducing health costs and decreasing the number of uninsured.  Parente predicts consumers will face significantly higher premiums this year  and these premiums will spike by $4,198 per family by 2019.   By 2014, projects Parente, there will be 40 million uninsured, roughly 10% more than today.

None of these facts or projections are likely to narrow the partisan divide between Democrats, who believe in Big Government as the solution, or Republicans, who support the marketplace  with more power to the people as the answer.

Are conservatives small minded when they embrace  the Adam Smith principle that  those who succeed in business elevates society as a whole?  Or are they greedy entrepreneurs interested only their own self-interest even if tramples those below them? 

The question si answerable because it depends on one’s ideological point of view.   To date, it must be said top-down government control, as manifested by ObamaCare and the VA, has failed to achieve its goals – coverage for all, more ready access, shorter waiting times,  lower costs, high quality, better outcomes, and more economic security.  But it is early in the 10 year Obama plan. Maybe these things  will come. 

But the public is skeptical.  So am I, and so is Stanley Feld. MD, a leading spokeman for consumer-driven care,  whom I interviewed yesterday.   Feld maintains that the key to lowering costs, raising quality and speeding access to care, is focusing on the patient as the customer  with patients paying more directly for care through medical savings accounts, with patients being provided with financial incentives to take better care of themselves, with patients and doctors spending more time with each other, and letting consumers drive the system  with appropriate government oversight and with better information of what things cost and what the results are likely to be.

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