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.

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?

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.

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.

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.

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

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.