Wednesday, April 27, 2011

The Quack Remedy of Commercialization

Paul Krugman has a recent column, "Patients Are Not Consumers." He concludes the column by saying:
The idea that all this can be reduced to money — that doctors are just “providers” selling services to health care “consumers” — is, well, sickening. And the prevalence of this kind of language is a sign that something has gone very wrong not just with this discussion, but with our society’s values.
I like Krugman’s having the good common sense to realize that medical care is NOT all or only about money – and that we are in trouble if we think it is. The reduction of EVERYTHING to money is a key driver, I think, in making corruption invisible to people. As Krugman observes:
Now politicians and supposed reformers talk about the act of receiving care as if it were no different from a commercial transaction, like buying a car — and their only complaint is that it isn’t commercial enough. What has gone wrong with us?
James Kwak at the Baseline Scenario details research which shows that the more people think about money, the less admirably they act. As well, taking economics classes may have a negative effect on behavior:

Robert Frank, Thomas Gilovich, and Dennis Regan wrote two papers on this back in the 1990s that most of the professional economists out there already know. In one of their experiments, they asked undergraduates at the beginning and end of the semester several questions such as whether or not they would return $100 lost by a stranger at the end of the semester. They found that the proportion of students who gave more dishonest answers at the end of the semester than at the beginning was highest for students who took introductory micro from the mainstream economist, lower for students who took introductory micro from the developmental economist, and lowest for students who took introductory astronomy.

If there’s an effect here, I don’t think the mechanism is that economics makes you a bad person. Instead, it changes your expectations about what the rest of the world is like. If you are an altruistic person and someone teaches you that (a) most people are self-interested and (b) the world would be better if everyone behaved in a self-interested way, that is likely to make you behave in a less altruistic way.

I was really struck by Krugman’s words that: “and their only complaint is that [medicine] isn’t commercial enough.” Somehow, more commercialization has become the always-prescribed panacea to everything. The same universal nostrum is also prescribed for education. Recently in Texas, there has been a lot of emphasis in education in whether professors and research are on balance money-making or money-losing for their universities.

Commercialization is not only no panacea – it is often not a remedy at all, like other quack prescriptions. Fortunately, many good people within organizations that pay lip service to money as the only value do NOT act that way and do subvert their corrupt leadership. But we also need to challenge the frameworks that people use when they talk – very unrealistically – as though human beings were, above all, “consumers.”

In reality, life is NOT all about money – and we get in trouble when we act or think as though it is.


Steve Lucas said...

This is a quote from a doctor’s comment on another blog:

“etc patients are served best by co-management with a hospitalist to dot all the i's and cross the t's in order to ensure apppropriate compliance with third-party documentation standards needed for service recognition and payment.”
It seems many doctors have also taken econ 101.

I am personally having difficulty with those who posses a superficial knowledge of business. They read a book, or take a class, and then are experts. I have had multiple classes in many areas of business and years of experience and find the often simplistic approach many have to business to be very frustrating.

Delegating a task does not mean you have also delegated responsibility. Sales of a product will never reach 100% of a population and just because you were not convicted of a crime does not mean you are guilty.

Steve Lucas

Afraid said...

I'm not sure I agree with this statement from the post: "Fortunately, many good people within organizations that pay lip service to money as the only value do NOT act that way and do subvert their corrupt leadership."

If you are saying that the everyday healthcare providers will try to circumvent roadblocks put in their way by those that manage the money, I agree. However if you are saying that there is a large scale revolution to subvert the power of the people at the top of healthcare providers/insurers/pharma/device/HIT companies, I think that there is little evidence of that.

Certainly there is a mountain of evidence that no effective resistance has made or is making a difference. Like all of the industries we see that run as operations to fill the pockets of those at the top at the expense of customers and employees, healthcare industry companies of all sorts have become part of the crony capitalism rampantly encouraged by politics and government bureaucrats.

The revolving door where those in government do things that help the companies and soon after get rewarded with very high paying jobs in the industry they were tasked to fix or regulate is the problem. And I’m pretty certain that its all “legal” – no formal promises were made, but it is clear that the reward system works we see it every day as it is a hallmark of the PR put out by these ethically corrupt companies.

Look, each time a politician or regulator or government person is hired by the industry, the industry itself makes it big news. Does this PR help the image of the company with the general public? Heck no, we see through it.

What it does say though is “scratch our backs and we scratch yours” to those with a legislative, regulatory, tax, or enforcement power.

Sad and sick is our system with a chronic disease that we have/are globalizing every day. The only real solution is to break up large companies; put down the 800 pound gorillas that are strangling us.

APeticola said...

Yes, I WAS saying that "the everyday healthcare providers will try to circumvent roadblocks put in their way by those that manage the money." And in so doing they succeed in helping a lot of people, by bending and subverting the nefarious rules.

Unfortunately, I do agree with the rest of your post for the most part. For the most part, the perverse reward system IS working.

Afraid said...

Thank you for forgiving my rant. Regarding trying to do the right things: I see the same, doctors and nurses trying to make the best of a bad situation that makes it harder (and more expensive) for them to do their work.

I have watched a CEO spend a whole day of his and his subordinates with a concern about a baseboard put on the new marble hallway. I have watched a whole lab have its new floor ripped up and replaced because it wasn't nice enough for the chair of surgery. These same folks decided to cut medical staff "to match revenue" during a cyclic downturn.

What is this preoccupation they seem to have with marble and flooring?