I read a lot of articles about consumerism and how employees need to be better consumers. As one who implements technology, I am very familiar with most of the decision support tools in the market and all the online symptom checkers. So let me make a bold statement: It is all garbage.
I have always thought that individuals will never have enough knowledge to make educated healthcare decisions. Healthcare is too complex and always changing, so how am I ever going to have the time to keep my knowledge current? I don't want to, trust me. And the last time I needed healthcare, I was driving very quickly to the emergency room. Not a lot of time to think there.
I recently listened to a presentation that Aetna CEO Mark Bertolini gave a few years ago at Stanford. (You can find it here
.) The final question asked of him was: “How do you create a more educated consumer in a marketplace where they are directing their own healthcare decisions?” The answer surprised me:
“Trying to educate everybody on how the healthcare system works and the level of detail isn’t going to work. Sorry to say. And the reason is that, unless the amount of information I can gather is immediately available and that when I act on it has an immediate response, I am not going to pay attention to it.”
See also: Consumerism: Good, Bad, Future
With all the articles out there about consumerism and directing one’s own healthcare, I thought I was the only one that had such a view.
Every time I have my car fixed, I am wondering whether I am getting ripped off. I don't know enough about cars to shop the market for service. I remember watching 60 Minutes
or one such TV show where auto mechanics are shown taking advantage of everyday consumers by doing things people don't need. That's me. I wish I had a trusted auto consultant who would tell me whether I really need the services some mechanic is saying I need. You get my point. If I don't know whether my car is getting the proper treatment, how the heck am I expected to figure out whether my doctor is doing the right thing?
Just last night, my wife and I had a debate about the value of multivitamins, and we couldn't agree on whether they worked or were a waste of money. So I Googled the topic, read a bunch of articles — and I still don't know whether multivitamins work.
Let's not confuse choosing healthcare versus choosing health insurance. When choosing health insurance, is one supposed to be predicting what their needs are going to be in the next 12 months to essentially “game the deductible”? Insurance is supposed to protect one from an unanticipated event that may cause financial duress if one were not insured. Anything that doesn't fit into this category is simply a reimbursement plan. Dental insurance is almost not insurance. It is a prepaid reimbursement plan for most. There should be two types of insurance plans — one that runs like dental and is simply discounted reimbursements, and another that is real insurance. It is for this reason that health savings accounts should rule the day.
So what is the solution? I don't like it when people run around talking about the problems without giving viable solutions, so I won't do that myself. I always say stating the problem is easy; it is the solutions that are tough. Let me start with who I would want as a consumer. I would want someone who would give me sound advice as to what proper treatment is. I want someone who has an incentive to do the right thing for me. I want someone who would spend my money as if it were their own.
See also: Consumer-Friendly Healthcare Model
I think the solution requires properly placing incentives. I want to live a healthy, happy, long and financially viable life, just as I want my car to last long, be healthy and be financially viable. (I am not sure what a happy car would look like.) I want someone advising me who understands my goals, which I will safely say are more than likely shared by many. I am all about incentives. It is funny how, when you have the right incentives, you get better outcomes. That requires having someone who wants me to be healthy and not just fix me when I am broke.
There are emerging models out there that will provide this type of service. And making consumer-based decisions around the small stuff may become common. But, as a means of controlling healthcare costs, no way. We all know the majority of healthcare costs come from a few people with chronic conditions. If I need to have my oil changed, maybe I can shop the market. But if I need a new engine, I would hope to have a very educated mechanic at my side to help me make the best possible decisions.