"Putting Patients in Control"

Another wrinkle in the concept of putting patients in control of their own healthcare. Not only will most lack the expertise, time, or information necessary to make a choice, they may not even be presented with a choice. That is, the choice may be made by their doctor, for reasons not disclosed to the patient. Taking a look at medical devices,

“Doctors and technology companies are working in tandem,” [Jeffrey Lerner, the CEO of the ECRI Institute] explained. “The doctor has no idea of what the cost is and the consumer has no say in what products are chosen, for example, for hip and knee replacements.” He said doctors don’t care about the prices, and hospital CEOs don’t want to fight with their medical staffs, who can take their business elsewhere if fees are reduced. One student, who works as an operating room nurse, piped up and said that she had observed doctors threatening to do just that—take their cases to another hospital.

Lerner noted that health care consumers can’t bargain and find out the price of the devices and things that were implanted during surgery. Are they really getting the highest quality, lowest price artificial knee? Contracts are secret, and hospitals or doctors can be sued if they reveal what’s in them. “The laws are being used by companies against the consumer,” he said.

The result?

Bottom line: the doctor is both the buyer and seller of medical services for the patient. It seems to us that this is an area ripe for media exploration, especially since the president is now claiming that the reform proposal “puts American families and small business owners in control of their own health care.”

The type of control described in the President's memo is on a whole different level¹ than the WSJ/Newt Gingrich-brand of control under which, save for when catastrophic coverage kicks in, patients are expected make their own decisions about care and pay out of pocket or from a HSA. Yet once you choose your doctor, your further options may disappear into the maze of contracts and non-disclosure provisions. Dr. A charges less than Dr. B, but he's contractually prohibited from explaining why? What a wonderful context for making informed choices.

No matter who is promising control, it's important to think hard about what that really means.
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1. The memo speaks of control via making insurance affordable, setting up competitive health insurance markets, imprved accountability, ending discrimination based upon pre-existing conditions, and improving the budget over the long-term; choice of procedure or medical device isn't mentioned.