Ironic title, Corey. Some thirty-five years ago health care economist Uwe Reinhardt wrote a great essay called “Table Manners at the Health Care Feast”. And blaming the patients was barely on the menu then.
It’s not just the austerity. Here is why copays for healthcare display neoliberalism at it’s worst (which is admittedly hard to do): Neoliberalism obliterates the distinction between private goods and public goods. There are some truly private markets where price sensitivity still sucks but isn’t intolerable. Despite the inexorable crappification of airlines, being able to score affordable tickets is not a bad thing. But …
Do I need a Beemer or a Benz? No. Will it kill me not to have one? No.
Do I need an MRI? How the hell should I know? Will it kill me not to have one? I have no idea. I just know that my doc looked alarmed when she told me to get to the Radiology Department right away.
That is the heart of the difference between health care “consumers” and many other consumer markets. (1) Consumers don’t establish the demand. Doctors do. (2) Consumers have precious little way to evaluate quality, price, or anything else because the health care industry deliberately keeps them in the dark. (3) Consumers never have to buy refrigerators while they or their children are bleeding, not breathing, or writhing in pain. Health care decisions are almost always made under duress.
The knowledge gap here is critical. Carfax, Consumer Reports, CNET, Gizmodo, and hundreds of other sites help us get on top of all sorts of mundane purchases. There is simply no equivalent in health care. Doctors, hospitals, hospices, drug companies, nursing homes, HMOs, and insurance companies all stand to make a buck off of our “decisions”. This arena will NEVER be improved by patient-centered information until squeezing the last dollar from us is no longer a blood sport.