Paul Krugman Gets It Wrong: The Consumer Should be the Boss in Health Care

In a New York Times editorial of April 21, 2011, Paul Krugman writes, "Patients are Not Consumers" then derides proposals to voucher Medicare as he feels this would turn patients into consumers. While not addressing the wisdom of vouchers for medicine, I strongly object to his contention that considering patients as consumers demeans patients and is a bad thing for health care. The opposite is true! The patient is the consumer of care, and the lack of attention to this fact on the part of the patient, the physician, and the delivery system is a major reason why health care in this Country is so dysfunctional.

By any definition, patients are consumers of health care services, and they should and do have choices and rights. They should demand the best of care and service from their provider. They have the right to be informed and empowered to make reasoned choices and to participate in their care. The fact that many patients don't get sufficiently involved in their care and blindly relegate decisions to their providers works to their disadvantage and diminishes the value of health care. In virtually all medical decisions, there are choices, and it is outrageous to think that the patient as the ultimate consumer of the therapy would not be entitled and expected to learn about and weigh in on those decisions. Moreover, for all but the most emergency-type care, the patient's active participation is essential for maximum therapeutic success.

The failure of providers and delivery systems to recognize and respect the patient as a valued consumer is amongst the greatest flaws in the system. In my professional career, in addition to having led a major academic health system, I sat on the Board of one of the world's most successful consumer-product companies. The motto of the Company is, "The consumer is boss." This isn't an empty slogan. It is at the very heart of the way the company does business. The company’s success depends on understanding and meeting the needs of the consumer. Only in health care, perhaps followed by the airline industry, do we find such an egregious neglect of the rights of the consumer.

I have often pondered why in health care does the patient (e.g. consumer) not play a far more dominant role in demanding the best in care, cost, and service? The usual explanations are that the patient rarely pays the bill directly and that issues related to health care are too complicated for the lay person to understand. While both explanations are plausible, they are increasingly less valid. Health care costs are a financial burden to all either directly or indirectly and charges are increasingly being directly borne by the patient. This trend will continue. Health care is complicated, but not incomprehensible and more and more resources are being provided to patients to allow them to weigh in on clinical decisions. Importantly, it should be incumbent on providers to provide more comprehensive patient information on their clinical options and costs of various decisions.

The health care industry must recognize that the patient is a consumer with rights and free choice. As patients become more involved in their own care decisions, they participate more in doing the things they need to do to lead to better therapeutic outcomes, greater patient satisfaction, and likely lower costs. Only recently has the medical profession begun to recognize the centrality of the patient in good clinical care. "Patient-centered care" is a new mantra and long over-due. Personalized health planning focused on prevention and active patient engagement is a great hope for meaningful health care improvement. Understanding the value and necessity of the patient as a valued partner in their own care is becoming basic to medical education and enlightened medical practice. The reason for this goes beyond the rights of the patient -- it creates better outcomes.

Thus, in medicine as in business, it is critical to understand that the patient is the consumer, the consumer is boss, and fostering this will be a good thing for health care.