Distorted Facts on Distorted Demand
The chief cause for the ongoing American health care crisis is…
I’m not really a political man. I don’t join parties. I don’t like ideology. I take ‘political aptitude tests’ when I’m bored. One time I tested as a “Liberal Economic Libertarian.” Another test, I surfaced as a “Moderate Republican.” It really depends on the issues.
Take health care reform. I’ve done some research in this area – mostly in the service of clients but also in covering healthcare issues for various business and lifestyle journals.
I came across an article written by a technologist named David Goldhill published this summer by Atlantic Monthly entitled How American Health Care Killed My Father. Almost as dramatic as an article I wrote titled “How Men Die.” But Goldhill’s had a deeper message about the present situation.
The article reads well, but I found it filled with many errors in research. Moreover, many of his assumptions are based on simple anecdotes; some understandably emotionally-motivated, but nothing that tells me that he reached out to people who have done considerable study in this area.
For instance, he decries any government involvement in health care delivery, then “concedes” that a ‘single-payer’ system – e.g., a public insurance system – may be a better solution. On this point, he doesn’t give many details. Moreover, I’m not sure how you get to a ‘single-payer’ system without government involvement. He goes on to make the very common mistake of using Medicare and Canada care as examples of how costs will increase and care will decline under single-payer. It’s a bad assumption because he assumes that consumption will always be constant.
My big problem with Goldhill and other health care opinionists is that they inventory the various causes of the ongoing health care crisis, but fail to define sustainable solutions. In Goldhill’s case, he acknowledges distorted demand but fails to identify where the distortion comes from. If he had, he wouldn’t have come to the conclusion that he makes (i.e., no government involvement, let the markets decide).
I focused my research on the distorted demand on health care services and found that the story actually begins in the early 1970s. That’s when “managed” healthcare took over the doctor-patient relationship. Instead of a personal relationship with your doctor (ala “Marcus Welby MD”) – there was a switchboard, an appointment desk, a patient timeline and productivity quotas. Doctors who wanted to participate in the new system were DISCOURAGED from offering preventative healthcare advice because the Managers said that such interactions were off task and wasteful (Greenfield, Kaplan, et al, 2003).
That’s how the two errors are related – when Goldhill notes the benefits of good patient-doctor relationships but fails to mention that every patient care research conducted for the last twenty years has found that good doctor-patient relationships (as opposed to cost-containment measures) tend to curtail demand (Gerteis, Edgman-Levitan, et al, 1993). Moreover, improved patient-doctor communication also produces measurable improvement in clinical outcomes (Greenfield, Kaplan, et al, 1985; 1988; 1989) – thereby reducing demand again.
And as most of us know, when demand goes down, overall cost to the system goes down. What’s not to get?
I’m engaged in the ongoing debate over health care because I’m concerned that none of the politicians seem to get it. I’d like to remove the distortions that were created by ‘managed care’ in the first place. Clearly, we must encourage greater doctor-patient interaction and reward doctors for dispensing wellness advice and resources. Perhaps the issue will be relieved as American health care experiences some ‘deprofessionalization’ – especially in manner of dispensing wellness services, treatment maintenance, non-critical care (Ehrenreich, 1978; “The Social Economics of Health Care” Davis, 2001).
By the way, variations of this concept are found under “Wellness Programs” or “Patient Wellness” in one proposal now circulating in the House and in the current draft of the so-called “Baucus Reform Proposal.”
Clearly, this is not an issue for politicians to solve – yet many people have been hoodwinked into believing that it is. Just remember that we’ve tried the political route and look where it has left us. Universal greed makes politics ill-equipped to provide a fair and timely solution for Universal Care. That’s why I believe every individual must stay engaged in this debate – support legislative efforts that make sense and do what we can to ensure that old mistakes are not repeated.
Note that I have included “soft” citations I have collected. They include various papers and other work by researchers. I plan to add full citations at a later date.