The right’s health care “revolution” is a scam

The consumer-driven healthcare revolution, trumpeted one conservative think tank a few years back, has only just begun.

Now, for anyone who has ever been inconvenienced by an encounter with the healthcare system or even worse, been on the receiving end of poor quality care, a medical error or a misdiagnosis a greater focus on consumer satisfaction might sound like just the right medicine for American healthcare.

So should we celebrate the recent rise of consumer-driven or consumer-directed healthcare plans? The premise of CDHPs essentially high-deductible plans, with an option for a health savings account is straightforward enough: If you shop for services with your own money, youll use less healthcare and hunt for better bargains, in the process forcing providers to improve quality.

CDHPs have grown rapidly in recent years. From a trivial 4 percent in 2006, CDHPs now account for a full 20 percent of all employer-based insurance plans. The trend seems set to continue in 2014: A survey from the National Business Group on Health last month found that CDHPs were considered the most effective tactic to control rising costs by large employers, with 72 percent already offering a CDHP, and 22 percent planning to offer only CDHPs in 2014.

Id wait to break out the bubbly, for, despite the utopian claims of its enthusiasts, CDHPs are more about cash than quality, more about cost shifting than consumer empowerment.

The consumer-driven healthcare revolution, it turns out, is likely to be neither revolutionary nor consumer-driven, but instead will only manage somehow to make the misfortune of getting sick an even worse experience.

One irony of the current craze with consumer-driven care is that its adherents seem surprisingly unaware that we already had an experiment with true market medicine in this country in the 19th century.

From the beginning, argues the legal professor T. S. Jost in his critique of the consumer-driven movement, Health Care at Risk, there was only consumer-directed health care in the United States. Patients paid out of pocket, there was no health insurance, and there were an impressive variety of equally ineffective practitioners, frequently engaged in brutal competition.

The system (if it can be called that) was basically a disaster, with the presence of a healthcare marketplace doing little to encourage quality in that golden age of quackery. What ultimately did improve quality at least to some extent was good old-fashioned regulation: medical licensure laws, the closure of low-quality medical schools, the Pure Food and Drugs Act, and so on.

Meanwhile, the poor of that era were generally left at the mercy of scattered and frequently inadequate charitable facilities if they were lucky. In later years, hospitals would not infrequently reject or otherwise dump sick patients deemed poor financial investments, a notorious practice that wasnt really addressed again, with regulation until the Emergency Medical Treatment and Active Labor Act of 1986.