I've been hoping that Paul Krugman would take on the ed deform issue. He has touched on it at times but his focus has been on health care. Today's column (Patients Are Not Consumers) takes on the use of the word "choice" - something we hear at every charter school co-location meeting -every parent and teacher and even young children are given the "choice" talking point.
Just change a few words in these paragraphs and it becomes a column on ed deform (emphasis is mine.)
Earlier this week, The Times reported on Congressional backlash against the Independent Payment Advisory Board, a key part of efforts to rein in health care costs. This backlash was predictable; it is also profoundly irresponsible, as I’ll explain in a minute.
But something else struck me as I looked at Republican arguments against the board, which hinge on the notion that what we really need to do, as the House budget proposal put it, is to “make government health care programs more responsive to consumer [parent/student] choice.”
Here’s my question: How did it become normal, or for that matter even acceptable, to refer to medical patients [parents/students] as “consumers”? The relationship between patient and doctor [student and teacher] used to be considered something special, almost sacred. Now politicians and supposed reformers talk about the act of receiving care [an education] 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.
What has gone wrong with us?
Nothing has gone wrong with US. Krugman does not tread in areas that might talk about the inevitable evils of a capitalistic system run amuck.
Now, what House Republicans propose is that the government simply push the problem of rising health care costs on to seniors; that is, that we replace Medicare with vouchers that can be applied to private insurance, and that we count on seniors and insurance companies to work it out somehow. This, they claim, would be superior to expert review because it would open health care to the wonders of “consumer choice.”
What’s wrong with this idea (aside from the grossly inadequate value of the proposed vouchers)? One answer is that it wouldn’t work. “Consumer-based” medicine has been a bust everywhere it has been tried. 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. America has the most “consumer-driven” health care system in the advanced world. It also has by far the highest costs yet provides a quality of care no better than far cheaper systems in other countries.
But the fact that Republicans are demanding that we literally stake our health, even our lives, on an already failed approach is only part of what’s wrong here. As I said earlier, there’s something terribly wrong with the whole notion of patients as “consumers” and health care as simply a financial transaction.
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.
That’s why we have medical ethics. That’s why doctors have traditionally both been viewed as something special and been expected to behave according to higher standards than the average professional. There’s a reason we have TV series about heroic doctors, while we don’t have TV series about heroic middle managers.
The idea that all this can be reduced to money — that doctors are just “providers” selling services to health care “consumers” — is, well, sickening. And the prevalence of this kind of language is a sign that something has gone very wrong not just with this discussion, but with our society’s values.
The deal between Obama and the Republicans extended the voucher program in Washington DC and the Indiana Senate just passed the strongest education voucher law in the nation. Want to hear more about how the 20 year voucher program in Milwaukee has failed just read Diane Ravitch - or watch this Ravitch Interview on Channel 13.
Check out Norms Notes for a variety of articles of interest: http://normsnotes2.blogspot.com/. And make sure to check out the side panel on right for news bits.