New York Times columnist Paul Krugman may have a Nobel prize in economics, but in his recent commentary on the Independent Payment Advisory Board, he sure doesn’t sound like an economist.
(I don’t know what to think about the Board itself. On the one hand, price controls are pretty much always a bad idea. Probably the only worse policy for American healthcare would be to start shooting doctors. On the other hand, the board is supposed to determine how much the government is willing to pay for healthcare, and someone has to do that.)
Where Krugman goes off the rails is in his writing about the doctor-patient relationship (emphasis mine):
But something else struck me as I looked at Republican arguments against the board, which hinge on the notion that what we really need to do, as the House budget proposal put it, is to “make government health care programs more responsive to consumer choice.”
Here’s my question: How did it become normal, or for that matter even acceptable, to refer to medical patients as “consumers”? The relationship between patient and doctor used to be considered something special, almost sacred. Now politicians and supposed reformers talk about the act of receiving care as if it were no different from a commercial transaction, like buying a car — and their only complaint is that it isn’t commercial enough.
What has gone wrong with us?
What has gone wrong with us? Dude! What has gone wrong with you?
I first got interested in economics after reading a few of Krugman’s early popular books on the subject, before he was nearly so well known. I’d actually had some economics classes in college, but I’d forgotten most of what I learned. The only economic thinking I encountered on any regular basis was in newspaper editorials and on talk shows, and it was all kind of a confusing mess. Reading Krugman’s books reminded me that economics is a real discipline with a respectable body of knowledge.
So why are people referring to medical patients as “consumers”? Because that’s what they are. Because that’s what economists call them. Because that’s what economists call the end-users of every good or service: Consumers.
It’s kind of like if you ask a physicist what will happen if you bounce a superball in an airplane while it is doing an upside-down loop. In his answer, he’s going to talk about the mass of the ball, the mass of the airplane, and maybe even your mass, because for purposes of certain physics problems, a ball, an airplane, and a person can all be treated as objects that have mass. (In fact, it’s common to say the are masses.) It is this ability to recognize and use common aspects of different parts of different problems that makes it possible to reliably use the same simple physics equations in so many different situations.
Economics works the same way. Consumers everywhere have certain behaviors in common, regardless of what they’re consuming. It is because we recognize this fact that we can reason about different economic situations without having to learn all about each one from scratch.
Refusing to recognize that patients are consumers is refusing to admit that patients will be subject to all the same economic incentives as every other consumer. Unless you have damned good evidence to support that claim, it is probably a recipe for an economic policy disaster.
Or a sign that someone is trying to trick you.
(Hat tip: Peter Suderman)
Mark is a computer programmer, website builder, photographer, and sometimes journalist in Chicago, where he also writes the long-running Windypundit blog.