What matters in an optimal consumer health care market


An excerpt from Are We There Yet?: The Road to Universal Health Care.

Getting your business matters. Much of what’s happening now in health care and retail markets concerns pleasing you, health care consumers and patients, and getting your business.

The internet matters. You’re almost all wired now. The internet is shortest and quickest route to your heart, mind, and pocketbook (84 percent of you are now making purchases on Amazon).

Convenience and location matter. That’s why health plans, big stores, hospitals, and physicians are simultaneously consolidating and decentralizing – to give you a one-stop store shopping experience from home as an alternative to the multistore physical shopping experience.

Direct patient care matters. Wouldn’t you like to go to your personal doctor for a modest monthly fee to include lab tests, EKGs, most medications, and unlimited time with your physician? Of course, you would

Size of organizations matters. It takes a critical mass to get big things done for the consumer. That’s where big corporations and big health plans come into play and why the CVS-Aetna, Albertson-Rite Aid, Cigna-Express Scripts, and other mergers are taking place. That plus fear that Amazon might suck profits out of their businesses.

Type of health plans matters. In general, self-funded plans, which comprise about 1/3 of employer-based plans, offer more flexibility than plans relying on outside the company health plans. Self-funded plans can contract directly with cash-only physician organizations.

Price matters. More than half of you now check prices before you receive care, and doctors and surgical centers are beginning to post their prices in offices or online.

Cost of transactions matters. What it costs to make health care transactions matters — in travel and waiting time, in time away from the job, in understanding what transpired.

Transparency matters. The greatest strength of the free market medical movement is the online advance pricing of costs of bundled services for surgical procedures and primary care visits, so you know what you’re buying.

Bureaucracy matters. Somehow the U.S. has managed to create a convoluted bureaucratic health system. In some cases, physician-owned organizations can bypass and be free of health plan and government bureaucracies.

Access of patients to your own information matters. In the future people will demand access to clinical information compiled during office visits and hospital stays, information embedded in their electronic medical records.

Diversity of health plans matters. Different people of different background of different ages, backgrounds, incomes, and genders have different needs and may need different health plans.

Quality matters. Online you can now find quality ratings for doctors and hospitals. Unfortunately, quality is an elusive concept. It means different things to different people, so most of you still rely on word-of-mouth and institution reputation.

Minorities matter. 30 percent of U.S. population are minorities, and they form much of the uninsured and the poor. They overwhelmingly vote Democrat. The U.S. has the most ethnically diverse population among developed nations.

Employment by health care organizations matters. These organizations employ more people than any other business sector.

Personal interaction with physicians matters. There are limits to online connections and machine learning. Machines, apps, and algorithms can supplement but can’t replace the touch, feeling, sound, body language and presence of fellow human beings telling their stories.

Language matters. As the political correctness movement illustrates, as elites frenetically try to assert their moral and intellectual superiority, to regain power, to please without offending, and to diminish political opponents.

Morality matters. Morality is the foundation of civilized society. Society provides coverage and minimizes the suffering of the Have-nots by taxing the Haves.

Government matters. But less than you might think: Washington and state capitols may be too far removed from your homes, too much in gridlock to make a difference, too hamstrung by reams of red tape, and too hung up with red state-blue state philosophical chasms.

Organizational size matters. Size is often what it takes to get big things done although most big innovations still come from ideas from bottom-up entrepreneurs thinking big outside traditional hospitals systems and physician practices.

Humanity matters. Treat other people as if they possessed precious hearts and souls. Everything else will follow.

Physician morale matters. People become physicians to care for you, and if they think they’re merely wards of the government, their idealism fades, they become less effective in caring for you, and many of them suffer from “burnout,” with loss of morale, increased suicides, and departure from medical practices.

Complexity matters. As George Halvorson, the CEO of Kaiser Health, pointed out in his excellent 2007 book, Health Reform Now!, systematic attention across the nation to exorbitant costs of chronic disease, communication between doctors by electronic medical records, importance of data to measure performance, profit incentives among hospitals and physicians, matter too, sometimes negatively.

Voters’ trust matters. Only you can reconfigure Washington, and only you can replace self-serving politicians with politicians who have earned your trust.

Richard Reece is a physician and the author of Are We There Yet?: The Road to Universal Health Care.

Image credit: Shutterstock.com

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