money, coins, hands, wallet

(photo: Newton Free Library)

I’m glad to see that Paul Krugman has attacked the absurd idea that health care patients should be treated as consumers, and Jonathan Cohn has chosen to echo Krugman’s argument.  What I can’t understand is where was powerful denouncing of the absurd idea that we need more “consumer-driven” health care during the debate over the Affordable Care Act? From the New York Times:

What’s wrong with this idea (aside from the grossly inadequate value of the proposed vouchers)? One answer is that it wouldn’t work. “Consumer-based” medicine has been a bust everywhere it has been tried. To take the most directly relevant example, Medicare Advantage, which was originally called Medicare + Choice, was supposed to save money; it ended up costing substantially more than traditional Medicare. America has the most “consumer-driven” health care system in the advanced world. It also has by far the highest costs yet provides a quality of care no better than far cheaper systems in other countries.

But the fact that Republicans are demanding that we literally stake our health, even our lives, on an already failed approach is only part of what’s wrong here. As I said earlier, there’s something terribly wrong with the whole notion of patients as “consumers” and health care as simply a financial transaction.

After all, the entire principle underlying Obama’s health care law is that he wanted patients to be treated more as consumers. The whole point of Obama’s push for expanded coverage with only private insurance marketplaces was to turn patients into “smart insurance shoppers.” The exchanges were sold by the Democrats as a consumer-driven way to reduce health care despite, as Krugman points out, the current private health care exchanges in this country having been a total failure at controlling costs.

Similarly, the entire intellectual and financial justification behind the excise tax was to make employer-provided health insurance more consumer-driven and price conscious. It was designed to increase people’s co-pays and deductibles with the intent of making them smarter health care consumers, instead of patients that only worried about getting healthy.

I fully agree that treating patients as consumers isn’t just base, sickening, and a proven cost control failure, but it is wildly unfair to act like this is some Republican problem.

When Krugman asks, “How did it become normal, or for that matter even acceptable, to refer to medical patients as ‘consumers?’” the answer isn’t some deep mystery. It was while the entire Democratic Party spent a year claiming what a fabulous idea it was to make us health care consumers–and Krugman cheered it on. Now we are simply reaping the whirlwind.