Medicare

Paul Krugman on How to Keep the Doctor-Patient Relationship Sacred: Less Commercialism, More Bureaucratic Oversight

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I'm going to assume he's not praying to IPAB.

Is nothing sacred anymore? Paul Krugman is worried, very worried about the way people speak about medicine.

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.

Sacred, eh? Maybe Krugman's doctor had an altar installed in his waiting room, but I don't think that's terribly common. It does, however, tell us something about the quasi-mystical way he wants to see medicine, in which bureaucratic expert-priests inform a compliant laity about what's best for everyone.

Why is Krugman so horrified at the notion that medicine be treated as a "commercial transaction?" Is it because medicine is sometimes needed to live—or to live a happier, healthier, more productive life? Maybe so, but if that's the case, then why isn't he worried about the crass commercialism of the grocery store and for-profit food markets? Or does Krugman maintain a special, sacred relationship with his grocer?

Krugman's LOLcat.

I would also be curious to hear how most doctors serving the American public would feel about the idea that medicine shouldn't be thought of as an economic transaction. Oh sure, it's a specialized craft and the best docs build relationships with their patients. But I don't see too many of them working for free.

Here's what I mean when I talk about medical consumers: Individuals making informed choices about the health services they want—and yes, that also means being informed about their cost. Krugman, of course, thinks this conception of medical markets is terrible because he thinks that when it comes to health care individuals either can't or shouldn't make those choices on their own.

Krugman wants us to believe that he's just following history showing that allowing individuals to act as medical consumers doesn't work: "'Consumer-based' medicine has been a bust everywhere it has been tried," he writes.

The evidence says otherwise: In a 2009 metastudy of high quality research, consumer-driven health plans that paired health savings accounts with high-deductible plans didn't simply lower health spending growth, they produced real savings. They even increased the use of preventive care. Last year, a RAND study of consumer plans found similar savings, but without the clear increase in use of preventive care. The classic RAND study of health insurance, almost universally agreed to be the most robust study into how individuals respond to health insurance, found that increasing cost-sharing—i.e., making consumers (there's that word again!) shoulder a greater share of the expenses and thus giving them an economic stake in the choices made about their medical care—reduced utilization and costs, but "in general had no adverse effects on participant health." Once again, consumer-driven care gives us: cheaper care, no generalized negative effects on health outcomes, and in some instances, greater utilization of preventive services. That's what Krugman calls a bust?

Look, it's obviously true that in some cases—say, when you've just been in a car accident and are being rush to the emergency room—you're not exactly making rational decisions about what treatments to receive. But that's not the only time you need medicine. It's not even most of the time. As Niklas Blanchard points out, non-emergency medicine such as outpatient care, drugs, and devices account for approximately two-thirds of all medical spending in the U.S. In many such cases, individuals can make informed decisions.

He wants YOU!

Individuals can also be consumers when shopping for insurance plans. The current setup, which pairs heavy government mandates with tax-favored employer-sponsored insurance, makes this difficult. But in a healthier medical marketplace, insurers would be able to design and sell plans to individuals who would make informed choices about what sort of coverage they need or want.

None of this allegedly ugly market-mindedness need spoil the doctor-patient relationship, which can indeed be a valuable part of the practice of medicine. But that's not unique: Great business transactions often run on great relationships (this is why companies with great customer service are so widely loved). It may be special, in some ways, but it's not mystical or sacred. It's a business, not a religion.

It's enough to make you question what Krugman really worships. If we're trying to keep the doctor-patient relationship special and sacred, is the way to do that through the imposition of small panels of bureaucratic experts working for the federal government? Maybe for Krugman, that is the sacred part.

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97 responses to “Paul Krugman on How to Keep the Doctor-Patient Relationship Sacred: Less Commercialism, More Bureaucratic Oversight

  1. Based on that picture of Krugnut’s cat resting comfortably on his gut, I would say Krugnut’s has a very good relationship with his grocer.

    1. I wonder if he and the cat share a brain. It looks like the cat is focused on something and using all of their combined brain-power while he stares slack-jawed into space.

        1. Original Song Title:
          “Dude (Looks Like A Lady)”
          Original Performer:
          Aerosmith

          Parody Song Title:
          “Krugman (Must Be Crazy)”
          Parody Written by:
          Immoral Liberal

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          Schmoozing at the ancient gray whore;
          His picture looks like slime on the floor.
          Some morons gave the Nobel Prize
          To this false prophet hack for his failures and lies! (All lies!)

          (Gaga! Gaga!)
          (Gaga! Gaga!)

          Witch hunt for some nutjob’s crime;
          Blames others for no civility.
          Without irony, in three months’ time,
          Says civility’s for the scoundrel refugee!

          (Gaga! Gaga!) Krugman must be crazy!
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          Should have known this doofus would be trouble
          When he called for a new housing bubble.
          So open your eyes; this guy’s just telling lies.
          When he went frothing at the mouth, it should have come as no surprise!

          (Gaga! Gaga!) Krugman must be crazy!
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          (Economy’s turning straight down…)
          Man, we’ve got a freak here!
          (Who the hell is paying this clown?)
          Screwy, screwy Krugy’s lost his head!
          (Krugy should be run out of town…)
          We’re up Krugy Creek here!
          (Filled up with the stream of his brown…)
          Pukey dooky loogie Krugy!

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          Dude, he’s freakin’ crazy!

          Meow! Woof woof woof woof!

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          Dude! Dude! Dude! Krugman must be crazy!
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          (Gaga! Gaga!) Ya ya ya yya ya yya ya chit chit yaow!
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          1. A Nobel Prize-winning economist who came out of a university in New Jersey is crazy? Sorry, but Milton Friedman (Rutgers) is dead and his ideas are a stinking corpse. Krugman is right. In other words, left. Credit for pacing, and there should be a category for wordsmithing, but this is not funny and not true.

      1. “Mr. Lieberstein! You speak of the considerations of the rights of others! How dare you, sir! How dare you! Where, sir, in any of this, were the rights of Mrs. Precious Perfect considered!?”

    2. He’s been unfairly exposed to hidden trans-fats. Poor obese fuck. No wonder he is bitter.

    3. You’re not kidding. I never studied that picture closely enough to realize just how obese the guy is.

    4. That’s the only pussy he’s gotten close to in awhile Id’ bet.

  2. Ew. Capitalism is icky.

    1. …like vaginas.

  3. Are there any pictures of Krugman where he is not blankly staring off into space?

    I would go so far as to say that teh attitude that Krugman wants to promote regarding medicine is a large part of what is wrong with the medical system today.

    1. You can almost see a string of drool coming out. Slack-jawed Princeton yokel but there it is.

      You know what’s even sadder? He’s about five-feet tall or so. Itty-bitty guy. But his brain is Nobel-sized!

  4. “I wonder why my fingers smell like ass?”

    1. I think he knows.

  5. Krugman’s technocratic mentality can’t fathom the idea of the vulgar masses actually interacting with their healthcare providers on any level of competency. The notion of pharmaceutical companies directly marketing to the consumer is verboten to statists like Krugnuts. Public policy should dictate what drugs are produced and only dispensed by hive-mentality medical beauracrats.

  6. “‘Consumer-based’ medicine has been a bust everywhere it has been tried,”

    Where exactly would that be? The little world that Krugman imagines inhabits the inside of his dryer lint?

    1. Please…there is no reason to support such assertions. The average individual has little knowledge of anything outside American Idol and their fantasy football picks, so throwing out this nugget of shit requires no substantiation. And seeing how Krugman is a Nobel-prize winner, it must be true.

      1. Krugman never won a Nobel prize, He actually he won the “Sveriges Riksbank Prize in Economic Sciences in Memory of Alfred Nobel” since Nobel himself never gave a economic prize.

        1. Split me, DJF. Split me like a bananna.

      2. Jesus!! I actually forced myself to read Krugnut’s article. Here is this “genius'” example of “consumer based” medicine:

        To take the most directly relevant example, Medicare Advantage, which was originally called Medicare + Choice, was supposed to save money; it ended up costing substantially more than traditional Medicare.

        MEDICARE!!! Fucking Medicare. A government program. Krugman is so intellectually dishonest it is nauseating.

    2. Consumer-based’ medicine has been a bust everywhere it has been tried

      I’m more confused by the idea of anyone other than the ‘consumer’ having a use for medicine.

    3. That statement about consumer based medicine being a bust drives me insane also.
      Pretty much consumer based medicine, e.g., dentistry and eyeglasses, is the only medical interventions that are affordable.
      When was the last time your heard about a crisis in eyeglasses? And is the fact that government isn’t involved correlation or causation?

      If government hadn’t gotten involved in defacto mandating health care in WWII, I dare say we would look upon medical care the same way we do dentistry and eyeglasses – more expensive than maybe we want, but easily affordable.

      1. My favorite comparo with insured care is elective surgeries. Shit like LASIK and face-lifts.

        Since insurance doesn’t cover them, its all Wild-West Evil capitalism in those procedures. Getting cataracts removed with lasers is about $5000-$10,0000 bucks. Using same lasers and such, LASIK is about $500 an eye.

  7. One thing is sure, with Obama’s “peace” & Krugman’s “economics”, Nobel prizes are experiencing hyperinflation.

    1. Krugman actuall did some interesting work on international trade and comparative advantage in the 70s. His problem comes like it does for most when they think they know best how others should live and move from the positive world to the normative. That never quite works out they way they plan.

      1. And of course there is always the “Lazarus Long” quotation.

        “”Expertise in one field does not carry over into other fields. But experts often think so. The narrower their field of knowledge the more likely they are to think so. “””

        1. Quoth the Iron Law:

          The less you know about something the easier it is.

  8. …that such a brilliant person could be so fucking thick-skulled.

  9. The classic RAND study of health insurance… found that increasing cost-sharing…reduced utilization and costs, but “in general had no adverse effects on participant health.

    I think the flipside results that they found, that with more comprehensive coverage people tended to utilize medical care a lot more and drive up costs significantly but without an increase in health status, to be more telling and a better counter to universal health care arguments. Going to the doctor more does not produce better results on average. Life expectancy gains all come from clean water and washing hands.

    1. Yep, and that extends to the “preventative care” myth that is such a big part of Obamacare’s pitch – and part and parcel of your “going to the doctor more” example.

    1. Nice link. Everyone hates stale porn. Especially Orrin Hatch.

  10. He’s right. Health care is an issue that cannot be compared to automobile insurance. I hadn’t heard improper grocery shopping could lead to death.

    1. Indeed it can. The other day a large woman ordered a ham sandwich and whilst eating it in situ, she choked to death.

      1. rather didn’t choke to death. Oh, I see… you mean some other large woman.

        1. Sugarfree, are you defrosting your ham wife on Sunday?

          Let me know if you get your Easter miracle but for fuck safe, reassemble the pieces correctly-you don’t want to pull a unit 731 on her.

          1. Yell louder. You’re just all gray and dim.

              1. SF, do you like my poopy?

                Please like my poopy!

      2. All the leaves are brown, and my face is gray…

      3. Mama Cass?

        I would’ve prefered had it been the Mama of Cass Sunstein.

    2. He’s right. Health care is an issue that cannot be compared to automobile insurance. I hadn’t heard improper grocery shopping could lead to death.

      WTF does insurance have to do with the interactions between patient and doctor? Only fools believe that patients shouldn’t question the proposals of their physician.

      “I keep going to this doctor, but I’m not getting any better. I wish I could seek out an alternative but our bond is sacred.”

      1. A “commercial transaction” by definition includes all payers, ergo the fucking insurance companies have a say in your care.

        He’s right, the relationship was between the doctor and the patient. The physician counseled his/her best advice but ultimately the patient decided on their own care.

        1. Then you either didn’t read the article or you are just as dishonest as Krugnuts. Lets get it straight, his statement about “consumers” and “sacred”, were loaded concepts designed to distract from his proposals on healthcare. Because HE advocates a third party to be involved with this “sacred bond”. His article describes having medical beauracrats interfering with the “doctor/patient” situation to control costs.

          Krugman is a political hack. His genius is in conveying blind partisan rhetoric to the gullible masses.

          1. I was commenting on Krugman’s quote and not the writer’s interpretation.

            It’s a business, not a religion
            No, it is more than a business because it is not based on consumer choice, but necessity.

            Cash pay is the solution with the elimination of all insurance but catastrophic care.

            1. No, it is more than a business because it is not based on consumer choice, but necessity.

              Then explain why I, and millions of others, have “shopped” for providers?

              Claiming that consumer choice doesn’t enter is patently absurd.

              1. The choice is of not being a patient. A true consumer can buy/rent products or not, but health care is irremissible.
                How have you shopped for providers? Was it through your employment?

                1. The choice is of not being a patient. A true consumer can buy/rent products or not, but health care is irremissible.

                  BZZZZZZZZT!!! Wrong!!! Your argument can be seen to be absurd by simply thinking past your nose. Because I highly desire healthcare, and at various instances can claim that I need healthcare, does not mean that I am not a consumer of healthcare. I MUST eat. I MUST have shelter. I MUST obtain clothing. All of these needs are met satisfactorally through a market based system, where I act as a consumer of other’s products/services.

                  How have you shopped for providers? Was it through your employment?

                  Currently, through the options provided by my employer. Previously, by shopping for individual plans. And in between such times, by paying for medical care out of pocket. And under all conditions, I made the choices based on what I perceived to be best for me.

                  1. There is not a food you must eat to survive; you can replace animal protein with vegetable.

                    There is no shelter you must live in or perish; you can seek shelter in an apartment or a house.

                    There is only one surgery for appendicitis; you can’t exchanged the procedure for a pap smear. Ergo, you are more than a consumer transaction.

                2. “Irremissible”: Not remissible; unpardonable; that cannot be excused or pardoned.

                  What are you trying to say with your fanciful use of the word?

                  Also, irremissible is an adjective and not a noun.

                  One could say, ‘irremissible crime’ but not “health care is irremissible.”

                  1. Mr. Notalwayswright,

                    irremissible – 1 of 1 thesaurus result

                    Define

                    Main Entry: mandatory
                    Part of Speech: adjective
                    Definition: required, necessary
                    Synonyms: binding, commanding, compelling, compulsatory, compulsory, de rigueur, essential, forced, imperative, imperious, indispensable, involuntary, irremissible , needful, obligatory, requisite
                    Antonyms: optional, unnecessary, voluntary

                  2. Mr. Notalwayswright

                    irremissible

                    Main Entry: mandatory

                    Part of Speech: adjectiveDefinition: required, necessary Synonyms: binding, commanding, compelling, compulsatory, compulsory, de rigueur, essential, forced, imperative, imperious, indispensable, involuntary, irremissible , needful, obligatory, requisite

                    Antonyms: optional, unnecessary, voluntary

                  3. Mr. Notalwayswright,
                    irremissible
                    Main Entry: mandatory
                    Part of Speech: adjectiveDefinition: required, necessary Synonyms: binding, commanding, compelling, compulsatory, compulsory, de rigueur, essential, forced, imperative, imperious, indispensable, involuntary, irremissible , needful, obligatory, requisite
                    Antonyms: optional, unnecessary, voluntary

                  4. Mr. Notalwayswright

                    irremissible

                    Main Entry: mandatory

                    Part of Speech: adjectiveDefinition: required, necessary Synonyms: binding, commanding, compelling, compulsatory, compulsory, de rigueur, essential, forced, imperative, imperious, indispensable, involuntary, irremissible , needful, obligatory, requisite

                    Antonyms: optional, unnecessary, voluntary

                  5. Mr. Notalwayswright

                    irremissible

                    Main Entry: mandatory

                    Part of Speech: adjectiveDefinition: required, necessary Synonyms: binding, commanding, compelling, compulsatory, compulsory, de rigueur, essential, forced, imperative, imperious, indispensable, involuntary, irremissible , needful, obligatory, requisite

                    Antonyms: optional, unnecessary, voluntary

                  6. Mr. Notalwayswright

                    irremissible

                    Main Entry: mandatory

                    Part of Speech: adjectiveDefinition: required, necessary Synonyms: binding, commanding, compelling, compulsatory, compulsory, de rigueur, essential, forced, imperative, imperious, indispensable, involuntary, irremissible , needful, obligatory, requisite

                    Antonyms: optional, unnecessary, voluntary

                  7. Mr. Notalwayswright

                    irremissible

                    Main Entry: mandatory

                    Part of Speech: adjectiveDefinition: required, necessary Synonyms: binding, commanding, compelling, compulsatory, compulsory, de rigueur, essential, forced, imperative, imperious, indispensable, involuntary, irremissible , needful, obligatory, requisite

                    Antonyms: optional, unnecessary, voluntary

                  8. Mr. Notalwayswright

                    irremissible

                    … mandatory

                    …. Definition: required, necessary Synonyms: binding, commanding, compelling, compulsatory, compulsory, de rigueur, essential, forced, imperative, imperious, indispensable, involuntary, irremissible , needful, obligatory, requisite

                    Antonyms: optional, unnecessary, voluntary

                  9. Mr. Notalwayswright
                    The spam filter won’t let me post but use a thesaurus baby. Mandatory is the main word

                    1. Mr. Notalwayswright
                      irremissible
                      … mandatory
                      …. Definition: required, necessary Synonyms: binding, commanding, compelling, compulsatory, compulsory, de rigueur, essential, forced, imperative, imperious, indispensable, involuntary, irremissible , needful, obligatory, requisite
                      Antonyms: optional, unnecessary, voluntary

    3. But it can with interior design.

  11. Don’t you know medicine is the ancient, sacred relationship between a patient, his doctor, and his government bureaucrat?

  12. If you think it’s hard to fire a complete screw-up of a teacher, just wait until your brain-surgeon is on the government dole.

  13. “The relationship between patient and doctor used to be considered something special, almost sacred. ”

    And just exactly what period in history was that this was the case?

    Perhaps Krugman can give us some specific dates to zero in on this “used to be” era.

    Because I can’t recall when it has ever been that way.

    1. When I was little the doctor held my nuts and said “cough”. But she still does that today — what’s the difference?

  14. Fear The Beard.

  15. I seriously wonder if Krugabe even bathes and clothes himself, or if he has an attendant to take care of these complex and vexing tasks.

    1. Isn’t that why people own cats?

      1. You have cats that can clothe you?

        1. I personally don’t deal with cats. I am not a cat fancier. I was dealing with the bathing part, obviously. I assumed that Mr. Brooks was being over-the-top on the clothing part.

          Sorry, I thought it was Good Friday, not Literal Day.

        2. I personally don’t deal with cats. I am not a cat fancier. I was dealing with the bathing part, obviously. I assumed that Mr. Brooks was being over-the-top on the clothing part.

          Sorry, I thought it was Good Friday, not Literal Day.

  16. This only demonstrates that Krugman does not recognize medical care as the luxury commodity that it is – a misunderstanding that pervades the whole health care debate.

  17. Why, why, why – Lord above – why do you waste time whining about the whining of some high-IQ buttinski prude and power worshipper?

    1. Because the morons currently running this country in the ground worship him.

      And I contest your High-IQ assertion.

    2. Because it is Krugman and so many “peddlers of second hand knowledge” like him that influence the masses and intelligensia alike.

      Bad information must be disemminated to become common-place.

  18. That cat photo reminds me of this one

  19. 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.

    Fucking goods and services, how do they work?

  20. … in the interest of being as polite as possible, and giving the proper respect to intellects as robust as the ones on display here, I will only offer that, perhaps, if the best you can offer is a few studies, and a lot of accusing an opponent of “maybe worshiping the government” perhaps you need to work on your argument a bit.

    1. In the interest of being as polite as possible, fuck off, slaver.

    2. So we offer evidence (studies) and make arguments about motives and these are bad things? We should instead rely on our “feelings”? I can’t understand your argument. Pot, meet Kettle.

    3. Exactly. How dare Suderman offer actual evidence to support his argument? That just gets in the way of Krugmans obfuscation!

    4. that grammar is way overdone.

  21. Original, documented investigation on Kaiser Permanente’s rigged end of life counseling, “Birth of a Real Life Death Panel,” is posted on http://www.hmohardball.com at http://www.hmohardball.com/Death Panel Birth & Attachments 1st in Series 2-14-2011.pdf
    Twenty years ago, Dr. Ezekiel Emanuel, ObamaCare’s ethics engineer, published that he had invented a scheme that induced 70% of patients to reject treatment and life support in a 15 minute end of life counseling session. He would deny her care, because she may not be able to meaningfully participate in the American “polity.”
    POLITICIANS, BUREAUCRATS, AND DR. STRANGELOVE PHYSICIANS ARE “BENDING THE COST CURVE,” BUT BREAKING THE PATIENTS AND DESTROYING THE DOCTOR- PATIENT RELATIONSHIP.
    Robert Finney, Ph.D.

  22. Where has he been? Everyone who receives a service, even one provided by tax-based funding, has been a “consumer” since at least the mid-90s. Recipients of Medicare, Medicaid, TANF, SSDI, and WIC are all referred to as “consumers” because they consume/use government services. Prospective government employees who deal with the public are questioned about their approach to customer service when they are interviewed for jobs. Public policy analysts talk about “return on investment” to the taxpayers for government entitlement programs. IMO, this change in nomenclature was intended in large part to de-stigmatize receipt of government largesse. Pauly is either unaware of the new usage or he fundamentally misunderstands its meaning.

    1. Krugnuts understands this perfectly well. He is intentionally loading the article with distractionary emotive bullshit. The placement of this paragraph is designed to get the reader to emote about some nostalgic time or feel some romantic notion of “sacredness” regarding one’s healthcare. Then the remainder of his article is how government beauracracy should interfere with this “sacred bond” in order to reduce costs.

      Krugs is not stupid. Dishonest, yes. Not stupid.

  23. How’s that Enron gig workin’ out for ya, Pauly?

    1. My checks didn’t bounce…all ~$35,000 for three days of work. I love Enron!

  24. I would also be curious to hear how most doctors serving the American public would feel about the idea that medicine shouldn’t be thought of as an economic transaction.

    My wife the orthopedic surgeon would have some choice words about Krugman’s assumption that she shouldn’t be running a for-profit commercial establishment, and instead should be employed by the government.

    If you could pay her enough money to get her to read a Krugman column. That would take a lot of money.

  25. Search on the web “Penny Health Insurance” if you have a condition such as high blood pressure, asthma, diabetes, cancer, depression or have had an injury, like a broken leg and need health Insurance NOW.

  26. Sacred, eh? Maybe Krugman’s doctor had an altar installed in his waiting room, but I don’t think that’s terribly common.

    Too bad Krugabe’s doctor-priest (witch doctor?) doesn’t practice the Aztec rite.

  27. I think Krugman’s point was supposed to be that sick people (say, people with cancer) don’t have the ability to effectively bargain-shop. They don’t have enough information, and they don’t necessarily know a lot about medicine. I’m not a medical doctor — I wouldn’t presume to decide what treatments I should get, because I don’t know what treatments work best. I’d want expert guidance.

    Then again, people who know they need expert guidance can choose to get advice. When a system permits choices, it also comes with rating systems and professional guides to help you make the best choices. (That’s why we have tax advisors, accountants, stockbrokers, and Yelp.) If we had a more choice-based medical system, I don’t think patients would necessarily be left in the dark, picking blindly; if the world were remotely sane, there would be science-driven resources to help guide personal medical decisions.

  28. I would also be curious to hear how most doctors serving the American public would feel new sexiness about the idea that medicine shouldn’t be free screensaver thought of as an economic transaction.

    yes~!

  29. yeah that statement about consumer based medicine being a bust drives me insane also.

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