But over the long weekend I was reading this article by David Goldhill in the Atlantic. Goldhill argues that the problem with American health care is that it’s not paid for directly by the consumers – sick people – but by the insurance industry. He points out how weird this is:
We can’t imagine paying for gas with our auto-insurance policy, or for our electric bills with our homeowners insurance, but we all assume that our regular checkups and dental cleanings will be covered at least partially by insurance.
So unlike other businesses, which have to focus on good service and competitive pricing to attract customers, health care providers can get away with half-assed service and Byzantine pricing schemes because their real customers aren’t the poor chumps in the paper gowns, but the insurance companies.
Goldhill also writes – and I’m arriving at the point, here, so stay with me:
It’s astonishingly difficult for consumers to find any health-care information that would enable them to make informed choices – based not just on price, but on quality of care or the rate of preventable medical errors.
It’s a matter for democratic debate whether health care should be a consumer good like any other; whether it should be paid for out of pocket, or by an insurance company, or by the government. But I think everyone would agree that citizens ought to be able to shop for a doctor in the same straightforward way that they shop for other services – by comparing prices, by looking for reviews online, and by asking their friends who they recommend.
Correction. I suppose there’s one group that would disagree: bad doctors.
People who are bad at their jobs rely on consumer confusion to keep themselves in business. No-one deliberately goes to a bad doctor twice; but many of us are too ill-informed to tell the difference between good medical care and bad.
The same applies, of course, for any industry. People innocently give their business to reckless real estate agents, clumsy carpenters, and visionless videographers.
Obviously, consumers suffer. And competent real estate agents, carpenters, and videographers suffer, because they lose business to hacks. You could even argue that the hacks suffer – they lurch along in careers they’re lousy at, instead of getting a clear economic signal that they ought to try a different line of work.
I think of StepRep and MyFrontSteps as an alliance between consumers and competent service providers. By connecting with the businesses they know and trust, people can steer their friends toward experts that won’t rip them off.
As you can see, this post has very little to do with health care. But it has everything to do with reform – reforming the way consumers think. We’re no longer powerless, even when we’re sitting in a waiting room wearing a drafty paper gown. The internet has given us amazing new tools for evaluating the quality of the services we pay for. We’ve just gotta start using them.