Actually, Mr. Krugman, patients are consumers
Last week, Paul Krugman wrote in the New York Times that “patients are not consumers.” He asks,
“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.”
My question is, how did it become acceptable to refer to people who receive health services as “patients” and to refer to the services themselves as “care”? Why did society decide to think and speak about health services as if they are fundamentally different from other goods?
I’m assuming that if Krugman objects to health services being treated the same as other services and products, he must be in favor of the prevailing system, in which people are widely presumed to be incapable of making decisions about their health and are expected to obey whatever doctors tell them to do. But this paternalistic view deprives people of dignity and freedom.
Krugman gives the following reasons for his view:
“Medical care, after all, is an area in which crucial decisions — life and death decisions — must be made. Yet making such decisions intelligently requires a vast amount of specialized knowledge. Furthermore, those decisions often must be made under conditions in which the patient is incapacitated, under severe stress, or needs action immediately, with no time for discussion, let alone comparison shopping.”
Perhaps medicine is an area where decisions tend to have weighty consequences and professionals tend to have extensive training. But this doesn’t make it fundamentally different from other professions. Chefs, photographers, interior designers, personal shoppers, and investment bankers all have training and expertise, and their work affects people’s well-being to various degrees, but people who use their services are still considered consumers, and it is also considered perfectly acceptable, by the law and society, for people to cook their own food, take their own photos, decorate their own houses, buy their own clothes, and invest their own money.
In all areas, people should have the right to make any decision they want, as long as it does not violate the rights of anyone else. This includes making decisions that are risky, unwise, or based on non-expert knowledge. I think that ordinary people are more capable of making medical decisions than Krugman gives them credit for – almost anyone can read about the benefits and risks of a medicine or procedure and decide whether they want it or not. But even if specialized knowledge is required to make certain decisions “intelligently,” people have a right to make unintelligent decisions. For situations where a person is incapacitated, we could create a system in which people can easily register their medical preferences ahead of time and know that they will be respected. Even when a person “needs” medical attention immediately, they should still be free to take as long as they want to decide (even if this is unhealthy), to make a quick decision themselves (even if it may be the wrong one), or defer to a doctor’s judgment if they so choose. And severe stress is certainly no reason for people to be unable to make their own decisions.
“The idea that all this can be reduced to money — that doctors are just ‘providers’ selling services to health care ‘consumers’ — is, well, sickening,” Krugman writes. No, the idea of doctors and their customers as equals, engaging in voluntary transactions, is beautiful. What is truly sickening is a society and legal system that considers it inappropriate for people to make decisions about their own bodies. Any change toward viewing people who receive health services as consumers is a good change, which the world desperately needs more of.
