I am a doctor’s kid, from a little town in Northern Ohio where my dad delivered one-third of my classmates into the world. Our family received bottles of milk from a dairy farmer in exchange for my father’s health-care services. Our family outings were routinely canceled because my dad had to leave to take care of someone else’s family.
When I was growing up, I heard over and over again that there was more to life than making a buck. That was how my dad felt about medicine. Before he went to medical school on the GI Bill, he worked in the steel mills. He thought of himself as a working class guy who had a job as a doctor.
Coming from his background meant caring for his patients and included considering their pocketbooks. Around one out of every four bills that he mailed out was not paid. He knew that a medical bill could mean a canceled vacation or no shoes for the new school year. He believed that the white coat meant something beyond a knowledge of medicine. There was also an empathy for the financial realities of his patients’ lives.
I am a businessman. When I buy a delivery truck, I expect that the car dealer wants me to pay more than I want to pay, and the car dealer expects that I want to pay less. When I take out a loan, I would prefer lower interest, and I know my banker would prefer higher interest. I do not hold this against my car dealer or banker, nor do I expect them to hold my self-interest against me. It’s just business.
But health care should be different. It’s not just business. Patients put their lives in the hands of their physicians, and they would like be able to trust their doctors’ motives. Because the stakes are so high, and because of the built-in profit motive in the health-care system, consumers can’t know who to trust when making decisions about how to spend their health-care dollars.
Can you imagine large numbers of people willingly paying more than the sticker-price for a car? But people regularly choose more expensive health-care plans so they can feel safer. They go along with a doctor’s advice to have a few extra tests, “just in case,” or request a drug that they’ve seen advertised on TV that they hope will fix a problem they are having.
When a physician or hospital group suggests that I come in for a procedure or to have a test done, I would like to know that if they were paying the bill, they would have this same procedure or test done. I do not want to find out that their recommendation is based upon making a buck, rather than on making me better.
When Americans spend two-and-a-half times more for health-care than other industrialized countries; when Northern California hospitals are charging $90,000 more for similar services than the more competitive Southern California hospitals; when doctors too often are unwilling or unable to tell patients what a proposed procedure will cost—the system is broken.
