Wednesday, October 7, 2015

Is responsible medicine anti free market?

So, since everybody wants to avoid the obvious answer to the question I posed in the diabetes thread, I thought I would consider a couple of slightly different angles. I get that for those right of center, there is this fabulous meme wherein it is believed that people will soon stop even wiping their butts because they will be waiting for someone in government to do it. It's not hard to accept the reality that if an individual doesn't have to work hard to survive, they are not going to do so. Well, except for the type A's of the world who live for the thought of killing or beating something or someone everyday. Nothing will change that meme. Still, as I move closer and closer to being an actual provider of health care making the shots on what tests, labs and medicines to order, I am seeing some insidious forces that I am not looking forward to dealing with.

The free market, like a recipient of government handouts, does not seem interested in working hard to produce the best outcomes. At least, they do not breed the best outcomes IF you believe a good outcome is helping a person live in such a manner as to not need medicine. In our market driven system, a patient will get whatever they want, whether it is actually called for or not. If you want an MRI, you will find someone who will give it to you who will word the note in such a manner to meet an insurance requirement and get them to offset the cost of your test. If you want an antibiotic, you simply brow beat your doctor until he gives it to you, or you go to someone else who will. This behavior has spawned a host of bugs that are now resistant to antibiotics they used to be sensitive to, all because people want antibiotics that are not required.

In the ICU, I took care of quite a few people who had a stent placed after a heart attack. Frequently, they had high cholesterol, or diabetes, or smoked. One lady I took care of was back within two months after vascular surgery to save her legs because she didn't stop smoking. For some people, that experience was a wake up call. But very often, I felt like I was participating in enabling people to live with very bad behavior. And as I mentioned in the diabetes thread, that illness is costing us hundreds of billions of dollars a year. Why are we paying that? Because it's what the participants in the market demand. If a doctor tells a patient they aren't going to give them something that isn't necessary, the patient will simply go to another doctor who will give it to them. If you don't give the customer (patient) what they want, you will lose money.

People complain about the high cost of medicine and for the next wave of "cost savings" they are going to fight to just pay providers less money, while still demanding they get everything they have right now. That is how free markets work, no matter how stupid the customer is and no matter how hedonist the behavior is that we are enabling, the customer is always deemed to be right. I think people like the idea of a doctor being a gatekeeper of the system, until they firmly believe they are being denied something they are fully entitled to because they have insurance, or because they read some article on the internet that is full of inaccurate information. My preceptor, so far, has been a fantastic example, he doesn't just tell people no without taking plenty of time to explain why. He doesn't need to do that, but he does it to protect both the patient and the system. If he was a true free market type, he would just give the patient's whatever they ask for, and I think he would be way way more popular.


  1. Simple answer, yes Max it is. It deprives insurance companies and pharmaceuticals of their GOD GIVEN RIGHT to earn enormous profits when the doctor acts in the total best interest of the patient

    1. Yeah, but it also denies the "customer" what they feel is an inalienable right and this is, IMO, a huge issue that we are going to have a very difficult time addressing. After spending 5 years in the ICU, and now spending close to 5 years in hospice care, I can say that I have participated in care that was futile at best and downright harmful at worst. Our system is geared towards rewarding insurance companies and drug companies and at present, it rewards physicians to "do things" rather than reward them for keeping people healthy and at present, that last issue is something I am just beginning to realize the complexity of.

      Customer service mentality is being drilled into organizations, which means that in order to get a good survey back from a patient or family, the provider will do a host of things that are not called for in order to provide a positive customer experience. I feel like this is causing an enormous amount of damage. I'd like to hear from the purists, but conveniently, they stay out of discussions like this lest they get into defending a socialist outlook they don't want to defend. Better to stay out and just blame the government for everything wrong with the system.

    2. Not true Mike... I have wanted to take some time to answer both this and the Diabetes tread but time is not on my side... I will get around to it and some other things that have been left hanging.... It may require a new thread to tie together several thoughts.

      In short there is plenty that can be done in the free market but for that to happen the many industry protections granted by government must change. I will throw out one little thought... The ACA has actually been a blessing in disguise as far as dismantling the association between hospital fees and insurance coverage with the discounts, kickbacks and government subsidies that reside in the middle..

      Gotta run....

    3. Fair enough. Ill be curious to hear what your take is on the effect that consumerism has on how expensive health care is. The patient is a customer and catering to customers is what free markets are about

    4. I agree Max that many demand demand demand or they bitch bitch bitch. I have found in discussions with the doctor, and I think that I have said this before, when you want minimalist care they don't quite know how to deal with you. Make me well with the least amount of pain, time and drugs and I am happy. I will give that shining review that one seeks.
      We have the same shit in the restaurant industry. Focus groups no let's put that in parenthesis "focus groups" that are consulted and asked opinions on what they want as far as service. The company comes up with some of the damndest shit I have ever seen. Rarely does it work and we are on to the next hot button topic that they have invented. I am a consumer and a somewhat picky restaurant guest since I know the business and I just don't get where they come up with some of the stuff. Oh and full disclosure I rarely gripe or complain in another man's restaurant because I know how it is some days. You, I am sure have been sick sometime in your life. Don't you wonder sometimes who comes up with some of these service issues you confront?

    5. I think a lot of this stuff is very, very simple, common sense. I think that more than anything else, people want to feel that they have had your full attention, and that you have addressed them as fully and as competently as you can. Many of the multiple hours long customer service presentations I have sat though dance around stating this directly and instead encourage us to work from "Scripts" that are nothing more than fake ass kissing.

      I've been a consumer of health, and the guy I am working with is so rare that I think it's a miracle I found him. He spends a lot of time with people and at times, he kinda argues with them when they are demanding something that makes no sense. In any business, you have to deal with a lot of personalities and some people just bitch no matter what and of course, those are ALWAYS the people that fill out survey's to let you know how much you sucked.

    6. I think I need him to be my doctor I like the minimalist approach