Imagine if food was a universal right in America, and citizens can forward the bill to the national government.
Wendy Lynch does so, and hypothetically describes a system which assigns an “RVU” value to weigh the cost of different meals. Examples include “basic oatmeal and fruit served at a diner in Omaha is assigned a RVU of 1 . . . for consumers needing special meals, a three-course, no-gluten, antioxidant-rich, organic meal prepared in an allergen-free kitchen, is assigned an RVU of 16.”
So, what happens? Well, you can guess what the unintended consequences are: “Chefs soon learn that having special skills means earning a better living. So, even though 85% of the population needs simple, nutritious-but-low-RVU meals, fewer and fewer chefs in culinary school undergo general, primary-food training. Cafeterias serving the basics like chicken noodle soup, baked fish and steamed vegetables have begun to close down because funds barely cover the cost of mass meal distribution. Soon, simple meals for families in places like Casper, Wyoming are almost impossible to find.”
Welcome to the world of the third-party payer, where the consequences will be the same no matter what industry it’s applied to.
{ 12 comments… read them below or add one }
Excellent analogy. The entire article is worth reading.
The analogy is false. How many diners do you know have cullinary school graduates? The local greasy spoon isn’t being run by a graduate of the CIA. Furthermore, we as a nation don’t spend billions in funds to train the next generation of chefs like we spend GME funds. Yes, there will always be the Bobby Flay’s of the world, and people will always pay more to eat at Mesa Grill, but people can also choose to go to the supermarket, pick up some supplies and make their own meals…the same can’t be said of medicine. What will happen is some entity, be it the government or be it WalMart, will fill that PCP niche, and med school grads may soon find their degrees are nothing more than a commodity beholden to those who move the market.
What if we extend this analogy and no one is expected to pay what the restaurant actually charges except for those that can least afford the high end cuisine?
Anonymous,
The analogy is about whether the customer (patient) has any influence on the cost of service (health care). It is an effective and accurate analogy. As long as the cost of the service delivered is hidden from the customer, there will be no attempt to provide what the customer really needs, or to control costs.
Restaurants should not be compared to doctor’s offices.
Similarly, doctor’s offices should not be compared to restaurants. A patient with the sniffles should not complain that their wait is too long if the office (or ER) is attending to sicker patients, or simply bogged down (phone calls, referrals, prior auths, out of network referrals, etc) by the burdens placed on primary care by the unholy alliance between the government (medicare/caid) and private insurance.
Consumerism in medicine is just as, if not more, destructive, to primary care than government involvement.
A family practitioner
Anonymous,
And yet the inability of the patients to see the cost they incur, is one of the reasons health care is delivered in such a ridiculous manner.
I suppose that you are disappointed by comparing medicine and food preparation. this is understandable, since food preparation has much more of an effect on good health.
Interesting comparison.
One problem is that the orginal post’s offer suggest food stamps instead of a 3rd party payer, and similary feels that something like a tax deferred health savings account (the McCain proposal) is the solution to health care.
The analogy falls here because it assumes that everyone needs about the same amount of food to survive, and those with enough money can choose to pay for better quality or more food if they desire. The problem is that where food stamps can likely buy enough food to prevent people from starving, health care for the sick is too expensive for anyone to afford. HSA’s work well for those who are generally healthy with the occaisional medical problem and the rare disaster (covered by catastrophic insurance). Once you start adding problems like diabetes, hypertension, emphysema, etc. treatments are simply not affordable. Food stamps/HSA’s don’t address these problems.
Anonymous,
Why isolate the patient from the cost of care? This certainly has not been an effective way of distributing care.
Every test for everybody in the ED has nothing to do with good patient care. Since the ED is cheaper than the pharmacy, and the ride is free with a return taxi voucher/bus token, there is no incentive to be reasonable.
Of course, we have to assume that if chefs are paid like doctors they also get to enjoy a monopoly over the food supply like doctors and the pharamaceutical industry, and you will have to have a prescription to get something to eat. That will require going to a primary chef, who will charge you $150.00 for a 5 minute consultation where he will determine what he thinks you need to eat. If you refuse to eat what he orders for you or you want something different, you will be labeled as non-compliant and possibly a “food-seeker” as well.
You will then take your food script to a restaurant, where you will wait two months for a table because chefs now have to be licensed to work and the American Chefs Association strictly limits the number of chefs to keep prices high.
Once you are seated for at least 4 to 12 hours the burger and fries your primary chef ordered for you will be served by a surly, arrogant and condescending waiter who informs you that if it were up to him, people like you would be forced to starve. You can’t understand what you did to piss him off, but this kind of behavior is common in waiters, so you settle down to eat your undercooked, skimpy hamburger and soggy fries anyway.
Dissatisfied with your meal, you complain to the waiter, at which point the waiter informs you that “I have other customers to serve” and walks away before you can finish your sentence. Naturally, you refuse to pay the bill, which is is $150.00 for the burger and fries, $200.00 for the waiter and $350.00 for the chef’s service. There is also a $100 table fee. No problem, within a few months, the collection agency is already calling to demand payment for a meal you “freely” ordered.
You consider paying $950.00 for a burger and fries that you used to be able to buy without a hassle for $6.95 to be outrageous, but what choice do you have? You have to eat. It really sucks being labeled a “food-seeker” when you ask for more food than the chef is willing to prescribe, or ask for a particular food by name, especially when you are paying so much for his services.
You are left wondering why you can’t just go to the store, buy your own food and cook it yourself without all the massive expense, humiliation, abuse and hassle like people did in the old days. The government and chef societies inform you that it if for your own good that they maintain control over the food supply, as chefs are better able to determine your nutrition needs based on years of training than your belly is. Meanwhile, you have lost 50 lbs, and are too weak and sickly to work any more due to lack of adequate nutrition, which makes it even harder to pay for the food you need. It’s a vicious cycle. When you report this to your chef, he tells you that food doesn’t seem to be helping you and cuts your food prescription even more.
Get the point how monopolies can drive costs far easier than overconsumption?
Rogue, consumers are seeing the costs of their care, but the results are not what was intended. Patients are opting to not fill prescriptions because of larger co-pays, and employers are passing along larger and larger shares of the cost to their employees resulting in self-rationing. Skipping a meal at the French Laundry isn’t going to have long-lasting effects on the consumer, but skipping their blood pressure meds will. Frankly, our disease-based model of healthcare only encourages more specialization by physicians seeking higher paychecks, consequently driving up prices to incredible levels. For healthcare costs to be reigned in it will take a wholesale reimagining of our system with the focus placed on preventative care. If that means networks of primary care facilities with WalMart, Target or Rite Aid labeling staffed by RNs, LPNs and Nurse Practitioners, so be it. Maybe we as a society need to ask ourselves if most care needs to be provided by an MD anymore? You make the consumer look really, really hard at costs and, like going to the car dealership for off-warranty maintenance, the assumption that you must see an MD for all your care will go the way of the house call.
Payne Hertz,
Your extension of the analogy into a different direction is fine, although the original point still stands (shielding patients from the cost of their care and rewarding specialists have clear deleterious effects, no matter what field you are in).
The sorry state of medicine today, including treatment of pain, has a lot of causes. Much of it is due to the third party payor system - which, again, reduces the influence of customer satisfaction on the whole equation. If everyone must play this horribly convoluted, red-tape-infested, game with Medicare, Medicaid, and insurance companies, and it is these third parties who hold the purse strings - then your satisfaction gets pushed farther down the list of physician priorities.
Add to this the inability of physicians to measure pain, the abuse and selling of narcotic medications by some patients, and the fining, jailing, and destruction of pain physicians’ reputations and you can see why you are in this circumstance.
If most restaurant owners netted out what physicians’ salaries average out to be, then they’d probably sign up for that in a heartbeat!