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Hey, Paul Krugman, patients should be consumers, not helpless pawns in an authoritarian politically-controlled health care system you support

Benjamin Domenech has an excellent response, as an open letter, to Paul Krugman‘s recent column and blog post titled, “Patients are not consumers.” Some excerpts

Your column and blog contain a ludicrous and incorrect depiction of health care needs in America, painting a picture where visits with a medical professional are always preceded by a call to 911 and a trip on a blaring ambulance – which is the experience for approximately zero Americans, anywhere. I would be eager to learn of any of your research showing otherwise.

A simple glance at a cost breakdown of the American health care system eradicates your fanciful depiction. According to the U.S. Department of Health and Human Services and the Agency for Healthcare Research and Quality, as much as 75 percent of health care costs in the United States are due to chronic conditions. …

Your incorrect view of the nation’s health care reality is, in fact, one of the chief reasons for problems with the current system, which was originally designed in the 1930s to cover catastrophic events, not chronic conditions, predictable treatments, and long-term care. …

There is some irony in your mistake and in his, in that the government-managed coverage systems you favor are perhaps at their worst in providing responses to the life-threatening illnesses you apparently think all of us are faced with on a daily basis. …

via Consumer Power Report #269: A Letter to Paul Krugman – by Benjamin Domenech – Consumer Power Report.

See also this breakdown of medical spending on different types of treatment.

Are patients consumers?  In 2006, CBS News reported:

Like millions of Americans, Gary Garcia is shopping online, CBS News correspondent Wyatt Andrews reports. But he’s not on eBay or Amazon.com. Garcia needs a new heart valve, and he’s shopping for surgery.

Using a Web site called Health Grades.com, Garcia learns which nearby hospital is the best at heart surgery — and then, to his amazement, he gets an estimated breakdown of the costs. He gets the list price for his operation, the discounted price his insurance will pay and his estimated co-payment.

Check out the video, too.  Vimo.com provides similar information.  There’s also MediBid.com. Its site says:

Patients can find a doctor, family physician, chiropractor, dermatologist, surgeon, dentist, or any other medical specialist on MediBid.  The process is simple; patients register as “Seekers” and post a secure, private request for medical care for anything from acupuncture to total knee replacement surgery or stem cell therapy for cancer. … More than a medical directory, MediBid is a resource where medical consumers can find a doctor, then actively seek bids for the care they need. It gives physicians a direct connection to their patients.

And don’t forget about medical tourism, and North American Surgery, Inc., which offers US-only medical tourism. Is Krugman aware of this?

Krugman claims that “‘Consumer-based’ medicine has been a bust everywhere it has been tried,” but provides no evidence for this.  Has he looked at the successes of employers such as Land O’Lakes, Wendy’s, and Manitowoc County, Wisconsin?  Or how about the results of a study by the The American Academy of Actuaries: Emerging Data on Consumer-Driven Health Plans, which includes cost savings, containment, proper & preventive care, and evidence-based care.

Krugman also wrotes:

Medicare Advantage was supposed to save money; it ended up costing substantially more than traditional Medicare.

Not so fast.  A Pacific Research Institute study states:

“In a very narrow sense, Medicare Advantage plans cost more per beneficiary than traditional Medicare,” said [study author John R.] Graham. Medicare Advantage increases the total costs of Medicare by about $12 billion a year, or about 2 percent. However, because traditional Medicare (a government monopoly) does not pay providers enough to cover their costs, they shift costs to the privately insured. This imposes a “hidden tax” on privately insured Americans that accounts for $49 billion a year: four times greater than the narrowly defined extra costs of Medicare Advantage.

Krugman states: “America has the most “consumer-driven” health care system in the advanced world.”   Really?  One might measure this by how much patients spend on medical care “out of pocket,” that is paying directly with their own money rather than with cash.  At the Health Affairs blog, Thomas Miller and Rohit Parulkar write:

U.S. OOP share of health spending, as of the last comparative figures available from the OECD in 2008 (12.1 percent), was below that of Germany, Canada, and the weighted average of all reporting members, respectively.

Krugman also states: “It also has by far the highest costs yet provides a quality of care no better than far cheaper systems in other countries.”  Krugman provides no citations for evidence to this claim.  For a well-references discussion of the data, see:

  1. Health Care Reform: Do Other Countries Have the Answers?, by by John C. Goodman, Linda Gorman, Devon Herrick, and Robert M. Sade.
  2. Myth Two in “The Top Ten Myths of American Health Care: A Citizen’s Guide”, by Sally Pipes (purchase, or view PDF for free)

Stepping back from these details, ask yourself: So what if Americans spend too much on medical care?  Do you care if Americans spend too much on car repair?  No, because they are spending their own money, or, having paid car insurance premiums with their own money & made a claim, they are spending money from an insurance company. It’s a private matter, & no one else’s business.  Health care should be the same.  “Spending too much” is only an issue because of government policies that force us to pay for other people’s medical care.  (I think I’m paraphrasing Arnold Kling, here.)

Krugman concludes: “The idea that all this can be reduced to money — that doctors are just “providers” selling services to health care “consumers” — is, well, sickening.”  Krugman has also spoken well of “Medicare for all” and single-payer health care. But wait, back in 1999 the BBC reported that under England’s National Health System,

Up to 500 heart patients die each year while they wait for potentially life-saving surgery. … NHS patients are often put on a waiting list because of other pressures to health service resources. Only an “enormous injection” of cash could change the situation.

In 2008 a Daily Telegraph headline read: Patients ‘should not expect NHS to save their life if it costs too much’.

Shocking – under a single-payer system, people’s lives are just reduced to money!

See also “Diagnosing Krugman,” by Will Wilkinson. He writes:

[L]let’s examine Mr Krugman’s implicit premises. … whatever is [supposedly] crass and profane about patients exchanging money directly for doctors’ services is avoided if the patient-doctor relationship is brought within the matrix of politics. This seems odd to me …