We the Consumers

There has been much talk lately about the Consumer movement in health care. The health insurance industry has given us the Consumer Driven Health Care (CDHC), which has gained much traction in the marketplace in the form of high deductible insurance plans, where the Consumer, having “skin in the game” now, is expected to make informed decisions on how to spend his or her money on health care services. The Consumer is empowered and in control of health care expenditures.

And then there are the various Consumer advocacy groups demanding an end to the paternalistic approach to the practice of medicine. Doctors should relinquish control to the Consumer. Consumers should actively manage their care by obtaining and controlling their medical records. Consumers should be informed by the medical establishment of the latest evidence-based best practices, timely research and costs of treatment. The Consumers will then make an informed decision aided by a myriad of peer and professional information available on the internet.

That’s a lot of new responsibilities for most of us who have no idea how much a visit to the doctor costs and even less of an idea whether or not we need that stent, assuming that we even know what a stent really is. Well, since we are Consumers now, not just passive patients, let’s see how we stack up to our brand new responsibilities.

As part of the work of the Commission to Build a Healthier America, the Robert Wood Johnson Foundation released an issue brief in September, titled Education and Health. It turns out that 16% of us over the age of 25 never completed high school and 30% of us have no schooling beyond high school. The percentages are of course much higher for those of us who happen to be black or Hispanic. If that’s not enough, RWJF also found that 3% of college graduates, 15% of high school graduates and 49% of those that did not complete high school  posses “below basic” health literacy, which renders us rather ineffective in making decisions related to medical care. Since there is a strong correlation between parents’ educational attainment and their children’s predicted level of education, the future doesn’t bode well. “The United States is the only industrialized nation where young people currently are less likely than members of their parents’ generation to be high-school graduates.”

Moreover, it seems that health status is directly proportional to educational attainment. The RWJF study finds that those of us that never graduated from high school are twice as likely to report being in poor health than college graduates. The “good news” is that the uneducated seem to have a shorter life expectancy – about 5 years shorter than our educated brethren.

How do these numbers relate to our brand new Consumer status in the health care field? When it comes to CDHC, it’s pretty simple. Since lower education is, of course, associated with lower income, we will not spend any money on doctors until we find ourselves bleeding to death and having to go to the ER. We, the not so educated Consumers, know better than to spend $5000 we don’t have on fancy doctors. We should be able to save a boatload of GDP this way.

When the inevitable happens and we get that heart attack, assuming we survive, there will be decisions to make; educated and informed decisions. The doctor will hand us literature explaining the options we now have, and maybe refer us to some websites where we can get more information. We’ll have to decide whether to stick with what the dudes in the JAMA article are recommending or go with the NEJM study published just this week (lucky us), but first we need to read that 50 page pamphlet from the American Heart Association, so we understand the basics of our condition. Sounds great doc, we’ll be sure to read all of this stuff later, but if you were in our shoes, what would you do doc? Yeah, that’s what we were thinking too, let’s go with that.

To be sure, many of us did go to college and even graduate school, maybe even medical school. Most folks leading the Consumer empowerment efforts in health care are very well educated. They are thoroughly able and willing to direct their own care and that of loved ones. They will make sure that the government’s investments in technology and electronic medical records translate into better quality of care for the educated Consumer. How about the not so educated Consumer — will we benefit as well?

In essence Consumer empowerment in the health insurance space amounts to shifting a certain amount of financial responsibility and risk from the insurer to the Consumer. Some of us are able to shoulder this new burden. Many of us are not.

Consumer driven medical care translates into shifting some of the professional and moral responsibilities from the physician to the Consumer. Some of us are fully capable of taking these new responsibilities on. Most of us are not.

But do we really want to? Are we ready to absolve the medical profession of the need to make compassionate and morally charged decisions? Are we ready to transform our doctors into providers or “sellers” and ourselves into “buyers” or consumers in a “free market” where both buyers and sellers are solely motivated by their own selfish interests? Are we willing to trust that the “invisible hand” will actually materialize and create optimal efficiency? And above all, will these efficiencies benefit all Consumers, or just the usual, wealthy and educated suspects?

Speaking of efficiency, from Overcoming Obstacles to Health, also published by the RWJF in 2008, it seems that instead of looking for change under the sofa cushions, maybe we should be looking at fixing disparities in our society. There seems to be $1 trillion to be gained annually, with half of it directly linked to health care cost, if we just increased the education levels for all of us who never made it to college. And while we cannot dispatch one third of our population to campus overnight, it seems ill advised to concentrate solely on the symptoms of our national problems and ignore the underlying malignancy.

We the People are not ready to accept palliative care for ourselves and our Posterity.

Margalit Gur-Arie is former COO at GenesysMD (Purkinje), an HIT company focusing on web based EHR/PMS and billing services for physicians. Prior to GenesysMD, Margalit was Director of Product Management at Essence/Purkinje and HIT Consultant for SSM Healthcare, a large non-profit hospital organization.

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