Over and over we are hearing that health care has to become more of a market like retail, or maybe dining: educated consumers would comparison shop for the cheapest quality care, thus keeping prices down. This is the logic behind high-deductible insurance plans, which are on the upswing: “These plans give employees some ‘skin in the game’ and an incentive to not only better manage their health but also to be a more educated consumer” one CEO says. Funny thing, though: if health care is supposed to be more like coupon-clipping and waiting for sales, it appears that somebody forgot to tell the doctors.
The U.S. government is planning on using what are essentially secret shoppers to determine how accessible doctors are to new patients and whether they treat people differently based on what kind of insurance they have. Although such undercover operations are par for the course in areas like retail, doctors are rather apoplectic that they will be treated like a sales clerk at Macy’s. Some are even going so far to call it “Big Brother” tactics, which seems to be a bit much considering that one of the goals is simply to determine whether doctors are telling the truth when they say they will accept new patients on Medicaid.
What it really demonstrates, however, is that no matter how much people argue that shopping around for a triple bypass should be little different from shopping around for a new car, it’s not going to happen. Smart comparison shopping isn’t going to solve the problems of rising costs and limited access because most people do not see health care as a retail activity. It’s a life-or-death activity, and one where one party has an inordinate expertise advantage. It’s only thing to compare the MPG stickers on a car and how well it handles when you are on the highway; it’s quite another to try to compare post-op complication rates at various hospitals and put that into the context of procedure cost (if you can even find that information to begin with).
A policy predicated on the belief that health care “consumers” are going to be able to bend the cost curve all by themselves by careful cost-benefit evaluations is doomed to failure.