Competing visions of a reformed U.S. health care system have delivered, in each iteration for two decades, a blueprint for some version of a market-based solution. The Affordable Care Act with its emphasis on insurance “marketplaces” (a.k.a., exchanges) has set the country firmly on the path to a new paradigm of health care commerce. The idea was that empowered consumers, armed with better tools and transparent information about quality and cost, would make informed purchasing decisions based on personal preferences. And the new health care marketplace would function like . . . a marketplace.
Language has evolved to reflect this market orientation. “Consumers” increasingly has replaced “patients,” and the terms often are used interchangeably, to the dismay of many care providers. Treating care delivery as just another commodity bought by “consumers” and sold by “producers” profoundly misrepresents the nature of our work. It discounts the values of our profession and fails to recognize the ethical constraints and special obligations of clinicians — which are very different from those of a salesperson or stockbroker.
But, of course, defining people as either patients or consumers is a false dichotomy.
In the new marketplace, we are both consumers and patients. We each face a dizzying (and growing) array of options for insurance plans, provider networks, and institutions of care, all with their own financial implications. We are consumers when we make rational decisions about which health insurance to purchase, about tolerating financial risk, and whether the price of discretionary services represents value. And we will all be patients at some point — ill, frightened, in pain — bringing to that experience a very different set of values and needs that must be respected and attended to.
Historically, we assigned responsibility for “consumer” needs to health insurers and payers, and responsibility for “patient” needs to the medical profession. Friction and mutual animosity resulted — with carriers castigating physicians for reckless indifference to costs, and physicians demonizing insurers for insensitivity to patient needs and the unique nature of the physician-patient relationship.
What the new health care marketplace requires of all participants is shared responsibility for the needs and values we bring to our experiences as both consumers and patients. Organizations must respond to consumer needs for affordability, for accountability (on cost, quality, and transparency), and for reducing the complexity that is proliferating in the new marketplace. And we all must respond to patient needs for compassionate care that recognizes the whole person. The true test of emerging models of care delivery and financing will be: Are they are fit for these purposes? Are they up to the task?