Why are we transforming health care? Why do we feel compelled to act with such urgency and in such broad reformative strokes? Did we just wake up one morning shaken to our very core by the enormity of having to fill the same medical history form multiple times? Are we driven to bleak despair by the thought of an elderly homeless person having to suffer multiple bouts of disease requiring frequent hospitalizations? Is our battle-forged sensibility to human rights egregiously offended by the realization that some Americans live a few months less than people residing on the French Riviera? Or is it perhaps the American Dream, having fulfilled itself in all other aspects of our lives, that is now expanding to the next frontier of taming the health care system to individually and respectfully cater to our quest for eternal happiness? Or maybe it has something to do with cold hard cash.
Health care, we are told, is way too expensive. We are also told that this is really our fault because it is our job as consumers to police markets, and health care is a market. The original sin occurred in 1965 when we allowed government and subsequently third party payers to insert themselves into a well-functioning market, which relieved us from the need to exercise stewardship of our finite resources, and induced us to engage in reckless binge consumption of health care resources fueled by opportunistic greed of health care providers. The party, with its smorgasbord buffet and open bar, is over, we are told, because the institutions sponsoring this, decades long, shindig are going broke and cannot sustain our health care debauchery any longer. The obvious solution is that we resume our duties as consumers and actively engage in shopping for health care on our own dime, and at the same time our sponsoring benefactors will endeavor to restructure the wild array of colorful and inefficient sellers into a lean health care machine better suited for modern day mass consumption.
Mass consumption requires mass production, which in turn requires proper division of labor, machines and networked computer software. Mass production increases the value and convenience of services for consumers. Pay attention to the terminology. We are talking about value, as in “how much car for the dollar”, not about absolute quality. A high enough value attribute allows cheap, low quality products and services to be presented as high value bargains for savvy consumers. The term convenience is a lot simpler to parse, since it is really an inverse measure of calories expended for the purpose of obtaining a particular service. You can buy anything today with half a dozen taps on your iPad, while sitting on the toilet, benefiting from the aggregate advice of thousands of similarly situated consumers. Nothing should prevent a modern day consumer from obtaining health care advice from the same locale.
Date: July 8, 2013