Consumer driven health care is a myth and aiming at the wrong target

The CEO of Humana recently gave a talk on the health care system in which he correctly noted some of the fundamental problems in the system (unnecessary care being provided, little concern for cost (of care) by the consumer, lack of electronic medical records, variations among practice patterns and others). However, he incorrectly concludes as do many other “experts” in and out of government that consumerism by the patient is the key to solving our health care cost problem. In other words, if you shop for health care as you do for a new television, you will be more prudent and cost conscious when it comes to receiving an MRI or CT scan.

Let’s see what you actually know about that new television. You certainly know the price and you also know that if you go to a big box, no frills store you may save money. You may know something about the perceived quality, probably from word of mouth or perhaps a consumer report of some kind. And you also know something else; if you guess wrong in your purchase you may return it for a refund or replacement, or if all else fails you throw it out, learn your lesson, chalk up the loss of a few hundred dollars to a bad experience and start over.

Sure, buying a TV is exactly like that severe pain your child feels on her left side accompanied by a very high fever; start shopping!

I have worked with thousands of people over the last fifty years as they navigate the health care system, deal with major illness, doctors, hospitals and their health insurance. Not one of those people knew the true cost of health care, not one could accurately assess the quality of care they received, not one knew if all the care received was necessary or appropriate. What they did know was that they or someone they loved were ill and wanted to get better, sometimes desperately so. On occasion (after the fact) there would be consternation over a high balance bill from a non participating physician, but more often than not the concern was that the insurer paid too little not that the doctor charged too much … “he saved my life.”

When it comes to health care we humans are not and can never be objective consumers motivated by cost (and sometimes even quality; witness the reaction to new guidelines for certain screenings that question popular wisdom).

All the well-known problems in the system must change, but it is the system that must change, not the consumer/patient. Why would we attempt to solve our problems by seeking to have 300 million people learn to question the next recommended MRI as opposed to changing the system so that we have confidence the next MRI is appropriate, necessary and cost efficient?  Let’s face it; if we believe that only external pressure from consumers can change the system, we are also saying the quality of health care in America is generally poor, overpriced, defensive and motivated largely by profit maximization.