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> Patients, even in the information age, cannot yet synthesize enough information to generally be intelligent, independent consumers of medical care Most peopl

by jquery 16y ago

> Patients, even in the information age, cannot yet synthesize enough information to generally be intelligent, independent consumers of medical care Most people don't know anything about cars, nor are even able to comprehend the complexity of your average vehicle, yet through trusted 3rd-party sources manage to find and purchase these extremely complex machines in a mostly-free market. Maybe as a future doctor you can explain why trusted third-party certifications would not emerge to protect the public if the government stepped out of the process? (I am genuinely curious)

carbocation 16y ago
Health care is like auto repair more than it is like purchasing an auto; you were born with this vehicle. I don't understand enough about cars to decide if I should buy Fuel Additive X that's being heavily marketed. Whether I buy it or not is pretty unimportant, because it's just for my car. If someone is trying to sell me an angioplasty, how am I supposed to decide for myself if I need it? Unfortunately, guessing wrong about the necessity of an invasive procedure is more risky than choosing the wrong fuel additive. No consumer guide can answer that question - and if it can, it can just label itself "medical school" and I'll respect that. Let's say that some guide says "angioplasty does not reduce mortality except in the setting of unstable angina or myocardial infarction, so don't get it." The doctor could come back and say, "yeah, but you have diabetes and that guide didn't look at studies with patients with diabetes." (Stuff like this is true and critically important to understanding clinical trials.) Or maybe you have atypical vascular architecture so the guides don't address that. I'm basically trying to get at clinical equipoise. Clinical equipoise occurs more often than you might think; it's a time where well-meaning doctors can disagree with one another because there is not specific enough data (or none at all) to answer the question at hand. I don't see a guide handling that. (Note that I'm saying nothing about whether or not patients can choose physicians intelligently - I think they do it quite well via word of mouth - but I'm referring specifically to the consumption of medical care like medicines and procedures.)
- jquery 16y ago
  First, thank you for your thoughtful and detailed reply. > Note that I'm saying nothing about whether or not patients can choose physicians intelligently I don't think I communicated very well... I was referring almost exclusively to this. Even this might be too specific... picking a good "provider" (e.g., a "brand", one level above a physician) might be the best an individual could do (since evaluating an individual physician might be too difficult). It's all academic, really. Since the government pays for medical services directly (via Medicare and Medicaid) it's a given that the government has to pay for a huge organization to vet the individuals and groups its reimbursing. This means there's not as much of a "hole" for the private market to fill...
- deleted 16y ago
  [deleted]
_delirium 16y ago
To me at least, that comparison actually makes me lean the other way, given how filled with corruption and fraud the auto market is (especially auto repair, which is the closest analog to health care). If the free market delivers health-care like it delivers car mechanics, then no free market please! I would love to be able to take my car to some semi-trusted government repair shop, even if it charged 2x as much and provided mediocre service, as opposed to having to try my luck at some shady local outfit, armed with no more information than some yelp reviews to determine which shop to go to. (I gather the dealers used to be this option---expensive but trustworthy---but it seems that lately dealerships are franchised with little enough oversight that you can't really trust them either; the Honda dealership near me is particularly shady.)

by jquery 16y ago

carbocation 16y ago

Health care is like auto repair more than it is like purchasing an auto; you were born with this vehicle. I don't understand enough about cars to decide if I should buy Fuel Additive X that's being heavily marketed. Whether I buy it or not is pretty unimportant, because it's just for my car. If someone is trying to sell me an angioplasty, how am I supposed to decide for myself if I need it? Unfortunately, guessing wrong about the necessity of an invasive procedure is more risky than choosing the wrong fuel additive. No consumer guide can answer that question - and if it can, it can just label itself "medical school" and I'll respect that. Let's say that some guide says "angioplasty does not reduce mortality except in the setting of unstable angina or myocardial infarction, so don't get it." The doctor could come back and say, "yeah, but you have diabetes and that guide didn't look at studies with patients with diabetes." (Stuff like this is true and critically important to understanding clinical trials.) Or maybe you have atypical vascular architecture so the guides don't address that. I'm basically trying to get at clinical equipoise. Clinical equipoise occurs more often than you might think; it's a time where well-meaning doctors can disagree with one another because there is not specific enough data (or none at all) to answer the question at hand. I don't see a guide handling that. (Note that I'm saying nothing about whether or not patients can choose physicians intelligently - I think they do it quite well via word of mouth - but I'm referring specifically to the consumption of medical care like medicines and procedures.)

jquery 16y ago
First, thank you for your thoughtful and detailed reply. > Note that I'm saying nothing about whether or not patients can choose physicians intelligently I don't think I communicated very well... I was referring almost exclusively to this. Even this might be too specific... picking a good "provider" (e.g., a "brand", one level above a physician) might be the best an individual could do (since evaluating an individual physician might be too difficult). It's all academic, really. Since the government pays for medical services directly (via Medicare and Medicaid) it's a given that the government has to pay for a huge organization to vet the individuals and groups its reimbursing. This means there's not as much of a "hole" for the private market to fill...
deleted 16y ago
[deleted]

_delirium 16y ago

To me at least, that comparison actually makes me lean the other way, given how filled with corruption and fraud the auto market is (especially auto repair, which is the closest analog to health care). If the free market delivers health-care like it delivers car mechanics, then no free market please! I would love to be able to take my car to some semi-trusted government repair shop, even if it charged 2x as much and provided mediocre service, as opposed to having to try my luck at some shady local outfit, armed with no more information than some yelp reviews to determine which shop to go to. (I gather the dealers used to be this option---expensive but trustworthy---but it seems that lately dealerships are franchised with little enough oversight that you can't really trust them either; the Honda dealership near me is particularly shady.)