CNN is reporting that part of President Bush's State of the Union Address will focus on health care. It seems that the problem with our health care system is that we're irresponsible consumers:
Hubbard said Bush's proposals arise from a belief that controlling health care costs requires choices to be driven more directly by a price-conscious, informed patient-shopper than by employers, insurers and others. The hope is that consumer demands will then drive the market into providing better and cheaper services.
As an aid to dkossers setting out to make informed medical-consumer decisions, I thought I'd offer a step-by-step analysis of the decision-making process I went through in choosing one of my doctors. Details on the other side.
Shortly after midnight on the morning of May 13, 1991, about six weeks after my 42nd birthday, I woke up feeling for all the world like I'd just wolfed down a dry roast beef sandwich which was now sitting like a lump at the base of my esophagus. But it had been several hours since I'd eaten, and although not painful, there was just something about it that didn't
feel right.
We made a call to my GP's answering service and talked to his partner, who was on call that night. His suggestion to try a couple of antacids didn't help, so we proceeded to his plan B recommendation. Half an hour later, after finding one of my wife's friends to come watch the three kids under 12 who were upstairs sleeping, we were on our way to the emergency room.
I don't know who else was waiting to be seen in the ER that night. All I know is that I said the magic words "chest pains", and went straight to the front of the line. The ER staff began asking a lot of questions and running a raft of tests--I can't even remember what all they did to me now, and I didn't ask why, or how much it was going to cost, or if there was a more economical alternative. Finally, at the stage of the night when they were supposed to come in and tell me, "It's only indigestion, go home," the ER physician explained to me that the tests indicated I was having a heart attack, that the cardiologist on call had been summoned, and was on his way.
A short time later a tiny little wisp of an asian man appeared by the gurney where I was being wired and poked and connected to a tangle of cables and tubes. He was so thin and almost ephemeral, I was afraid if I breathed too hard I might blow him away. He was barking orders--no, that's not right. He was softly and politely requesting things--people were just moving like he was barking orders. He put his hand on my shoulder and quietly explained to me what they were going to be doing. He wanted to use a clot-busting drug, TPA. He told me it was relatively new, that my insurance company might consider it experimental and refuse to pay for it (which they did), but in his opinion--because of my age, relatively good health, and the fact that the event was in the early stages--it was the best treatment option.
I didn't ask to be wheeled up to the hospital library to study up on cardiac treatment. I didn't ask if there were options to the TPA (Tissue Plasminogen Activator) that my insurance company would pay for. I didn't ask for a second opinion. I didn't go browse some website to check out the guy's credentials, or ask around to see if there was someone else I might like better. In that instant, he became my cardiologist, and he remained my cardiologist for almost fifteen years until he retired last fall.
I'm sure the puppetmasters pulling Bush's strings would say I'm a lousy consumer of medical services. I'm sure of another thing--that most of the public makes its medical decisions in much the same way. We walk into some medical establishment and "chose"--almost at random, because a friend recommended them, because they're nearby, because they happen to be available when we need someone, because they just show up next to the gurney where we lay wondering if we're going to live or die--the people who are going to provide us our medical care. And for the most part, we do what they tell us, without question, without asking how much it is going to cost. We assume competent and responsible care unless something happens that causes us to believe otherwise. That's the reality, and it's not likely to change.
Medical care has never been, and never will be consumed like a television or an automobile or a household appliance. And I suspect that Bush and most of his cronies know that--at least the ones not so blinded by their own ideology that they'll believe any free-market fairy tale that pops into some wingnut's head. That's why it's vitally important that we not allow conservatives to ram this market-driven fantasy of "WalMart-style healthcare for everyone" down our throats.
[Update 1/21/06: corrected an error I missed in proofreading the first paragraph of the extended body. Trying to rearrange a couple of phrases to make the section read more smoothly, I inadvertently moved my birthday 12 weeks. The incident took place six weeks after my 42nd birthday.]