December 19, 2005
Oh, to be a customer
A recent headline trumpeted: “Americans overpay for low-quality health care, survey finds”
It goes on: “Results show treatment often falls short, costs more than that in other nations”
As reported in the Washington Post by Rob Stein on November 4, “Americans pay more when they get sick than people in other Western nations and receive more confused, error-prone treatment, according to the largest survey to compare U.S. health care with that of other nations.”
“The survey…commissioned by The Commonwealth Fund…of nearly 7,000 sick adults in the United States, Australia, Canada, New Zealand, Britain and Germany found Americans were the most likely to pay at least $1,000 in out-of-pocket expenses.”
“More than half went without needed care because of cost, the survey found, and more than a third endured mistakes and disorganized care when treated. Though patients in every nation sometimes run into obstacles to getting care and deficiencies in treatment, the United States stood out for having the highest error rates, most disorganized care and highest costs.”
I suspect The Commonwealth Fund could have skipped the survey and just made the same assertions, which they do every year. If you say things often enough, everyone believes it, or at least thinks they heard that before, so becomes fact. This drum beat of everything wrong with the US healthcare “system” is beginning to fall into the advocates' favorite game of “create a crisis, solve a crisis.” Beware.
Americans have chosen as their healthcare system a technology based, information dependent, personal service.
What the survey really reports is the steady decline in the patient experience. The personal service aspects and point of service care delivery experience have been in massive decline for years. Why? Not only do we not invest in point of service innovation and experience, we prohibit it through a variety of regulatory restrictions. The most egregious are the Stark Regulations, though there is a mine field of federal and state anti-trust, anti-kickback and fee-splitting regulations.
Although the details of how the survey was done and the complete results are not known from the article, comparing the American experience in receiving healthcare to the rest of the world is a bit like comparing an airplane flight booked first class on, let's say British Air, and booking on Southwest Airlines.
Americans have excessive expectations while all the time over-regulating the possibility of a good experience out of existence. So, we book a seat for a first class experience on a first rate airline. Our expectation is perfection. On time. Great food. Great wine. Great service. Luggage arrives with us. Everything just right. But experts and the government have rules. They are for our own safety. Experience falls short of expectation.
However, everyone else in the world flies Southwest, the un-assailable leader of management to low expectations. One kind of plane. One kind of seat. The Rawhide boarding experience (Roll ‘em, roll ‘em, roll ‘em). No food. Jug wine for $5. No service really. You do everything yourself. But reliable transportation that many can afford. With a smile. The experience usually exceeds your expectations.
Brilliant.
Do we want a society where everyone MUST fly Southwest. No choice. I doubt it, though we are happy to know it's there when we want it.
And would Southwest be Southwest if it was owned and run by the government?? No way. Unimaginable.
So then we get comments from “experts.”“Other experts agreed, saying the results offer the most recent evidence that the quality of care delivered by the U.S. health care system is seriously eroding even as health care costs skyrocket. This provides confirming evidence for what more and more health-policy thinkers have been saying, which is, 'The American health care system is quietly imploding, and it's about time we did something about it,' " said Lucian Leape, of the Harvard School of Public Health.”
This is one of my favorite current assertions about the healthcare system: it is imploding. It is? What does that mean? Everyone always says it like it is something obvious. And if it is imploding that means what? The sky is falling!!!!
I get it!! The sky is falling and Harvard experts and the government have to fix it!! Oh yeah. Been here before.
A few years ago they just went with the idea that costs…which they, the Cartel, themselves drive relentlessly upward…were the crisis. Now they have thrown in lousy quality, which they themselves are accountable for, with cost. Cost alone didn't get them over the finish line. Scare everyone with the quality stick!!!
I think part of the discomfort of Americans about their healthcare system is we do pay a lot but we don't get anything approaching perfection. And we have no choice or control over how the money gets spent. This makes us very unhappy.
So what we have is a system where not everyone gets to fly. But those who do are FORCED to buy a first class seat on a full service airline and half of the employees work for the government. No choice. No chance to go Southwest. If our bags get lost or our food is cold, too bad. Go without if you don't like it. Very Politburo.
Surveys like this one, which is done every year, are pretty useless but are dutifully reported by the press as being some long sought after truth. And constitute the reason why we should turn our healthcare destiny over to the government and to experts.
The fact is we overpay for low-quality health because we HAVE NO CHOICE. If you had the option of being a consumer of healthcare services AND you had choice and control of how the money gets spent, you would not choose to buy lousy service and poor quality. Until that happens the healthcare system cannot deliver on expectations.
Robert B. Teague is a pulmonologist and business consultant who is based in Houston, Texas. E-mail him.
Read other blogs in this series.
