How So-Called Consumer Driven Health Care Distorts The Patient-Physician Relationship

Throughout the presidential campaign the Wonk Room emphasized the deficiencies of Sen. John McCain’s (R-AZ) consumer-driven health care model (in which the individual purchases health insurance coverage from an unregulated insurance market). In short, we argued that his plan allowed insurance companies to market sub-prime health insurance plans to the healthiest Americans while leaving individuals with pre-existing conditions without coverage.

Yesterday, the Journal of the American Medical Association, highlighted another consequence of commodifying health care — a fundamental re-ordering of the patient-physician relationship:

What has not received attention is that the consumer driven model implicitly calls for a fundamental reordering of the patient-physician relationship, placing increased reliance on commercial ethics while eroding professional ethics as the guiding force for patient-physician interactions.

The article argues that consumer-driven care — in which the consumer pays high-out of pocket fees and only uses health insurance for catastrophic expenses — could push physicians to “promote their own services to would-be patients, making unverifiable assertions about the cost and quality of the services they are selling.” Commercial competition would require physicians to deliver desired products at competitive prices without prioritizing their professional knowledge and “expertise to inform patients’ medical decision making and encourage judicious use of scarce health resources.”

In other words, with consumers “driving” their care, professional ethics, which “demand a fiduciary responsibility to the patient putting his or her needs above all else” would be swapped for market pressures, lowering health care quality and only increasing costs.

All this gets at the fundamental problem with consumer-driven care: it pretends that buying health care is the same as buying an IPod and ignores the fact that health care — in which the patient simply can’t know about the complexities of the treatment, outcomes are uncertain, and treatment is sometimes essential — is not subject to the benefits of the market. Indeed, the market often distorts the product.