Sunday, July 26, 2009


Matt Yglesias is somewhat disheartened:

David Leonhardt [of The New York Times has another in a growing series of great David Leonhardt pieces on the nutty and dysfunctional nature of "fee-for-service" medicine in which doctors are paid for doing stuff rather than for treating illness. The problem, however, is that to totally change how medical professionals get paid would be a big disruptive change, and I see no sign that the public really wants such a change....

Matt goes on to quote Leonhardt quoting one of the many polls showing that most Americans are satisfied with the health care they have, after which Leonhardt writes, "Americans say they want change, but they also want to preserve their own status quo."

Matt sighs:

I just don't really know what one is supposed to do in the face of public opinion data like that.

But when people say they're content, we don't know what it is that they're content with -- and I'm not sure they know, either. Presumably they want to be able to see a doctor when they're sick, or a family member is sick, within a reasonable amount of time; they want successful treatment for what ails them at what seems like a reasonable out-of-pocket cost.

But do they want lots of tests? Maybe, but I don't believe it. I think most people want medical attention when needed and a recommended course of action that leads to a good outcome -- whatever that may be.

I keep thinking back to an utterly necessary, invasive medical test I had nearly twenty years ago for symptoms that ultimately cleared up years later when I figured out I was lactose intolerant. If my doctor back then had recommended a dairy fast -- without precluding more hardcore medicine if needed -- I would have been thrilled; when I did ultimately cut out dairy as an experiment, I noticed the difference instantly. I've always felt grateful to the doctor at my college health clinic who diagnosed a lump I had as a harmless fluid sac by turning the lights off and shining a flashlight at it; his method was low-tech, but his diagnosis was spot on. I'm a hell of a lot more grateful to him than I am to the doctor who ordered an MRI for me a few years aghowhen my hearing showed a slight discrepancy in one ear; I spent forty-eight hours thinking I might have a tumor and then underwent an expensive, unpleasant, and, as it turns out, utterly unnecessary test.

Do patients at the Mayo Clinic or Cleveland Clinic even know they're getting some sort of "alternative" approach to medicine? How many people know when an average doctor would order a test and when one wouldn't?

Of course, when the difference is pointed out to average Americans, it's quite possible they'll get their backs up -- especially if opponents of reform encourage them to be suspicious. But there's no inherent reason that outcome-based medicine with fewer pricey procedures should be unsatisfactory to most people. If it were, you'd think we'd be reading about dissatisfaction, at least at first, among patients in non-fee-for-service medical care programs. But I haven't heard of anything of the sort. Sick people just want to get well.

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