On Liberal Elites and “Dumb” Patients
Just before the Memorial Day recess, liberal blogger Ezra Klein published an interview with Sen. Coburn regarding health care. Dr. Coburn’s responses can be found here, but in many respects Klein’s “questions” are themselves more interesting. Two in particular speak volumes to the liberal mindset on health care:
EK: Well, if you presuppose “properly regulated [markets],” then I doubt there are many examples. But IPAB seems like an effort to deal with something you’re worried about: The inability of Congress to act to reform Medicare. It’s an effort to more properly regulate the Medicare market….
EK: The question is how do you define excess? In the market version of this, it’s not clear that people know the care that’s best for them. When you say how many primary care physicians we need, it may just be that Americans like a lot of specialty care.
There, in a nutshell, lies the liberal philosophy: That patients are unable to make their own choices, and that government – in this case, the IPAB bureaucracy created by Obamacare – should do so instead. It’s worth examining each premise more closely.
The idea that patients cannot be intelligent consumers of health care permeates the left. Former CMS Administrator Donald Berwick perpetuated the belief, as have writers like Paul Krugman and Klein himself. At least at the most basic level, one can’t argue with the logic: It would be highly irregular – not to mention dangerous – for an accident victim riding in an ambulance to quibble about hospital choice. But a significant part of the health spending problem in the United States focuses not on acute episodes like heart attacks or car crashes, but on chronic diseases like diabetes and emphysema, which comprise three-quarters of all health spending. In these cases, patients certainly have the ability – and often the desire – to take better control of their health care, if only they were given the tools to do so.
The left argues in response that not every diabetic patient will want to spend time poring over “Consumer Reports”-esque ratings guides to find the most effective clinic or program that will work best for them. But as Harvard’s Regina Herzlinger has written, markets don’t assume – and don’t need – every consumer to be fully informed in order to spark innovation; they only require a leading vanguard of educated “early adopters” to spark change and competition.
After all, how many automobile purchasers know the intricacies of their cars’ ignition systems, braking devices, etc.? A car can be just as deadly an instrument as a surgeon’s scalpel – yet we don’t need a federally-created board like IPAB to “properly regulate” the automobile market.