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Why I Choose Low-Quality Healthcare

Mises Daily: Thursday, November 20, 2008 by

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Before the renewed discussions and debates over socialized healthcare begin in earnest, I want to make my preference known to all: I desire low-quality healthcare.

All right, to be straightforward, I do not actually desire low-quality healthcare; I simply do not desire high-quality healthcare — at least not "high-quality healthcare" as defined by generally accepted standards.

Time for some background. Once a year, around this time, my employer allows open enrollment in the various health plans the company offers. As I went through the process, I took the opportunity to review the physicians I had chosen for my family. In order to select the best pediatrician for my children, I used a feature provided by my company's website: a link to a database of physician ratings. I looked up my children's current doctor to see how he fared. What I found was interesting: he was not rated as well as I imagined. Luckily, the reason was just a few mouse clicks away.

The database rates physicians in three categories: quality of care, cost of care, and number of patients treated. My interest is mainly around quality of care for the following reasons: quality of care and children go hand in glove. His cost of care is not my issue (it is a third-party-payer system), and the number of patients is a statistic that can be considered both positive and negative.

So why was my chosen physician not rated near the top in the quality-of-care category? My wife and I like him. We have never had any problem with the care he provided to our children. Moreover, he gets excellent reviews from other parents who use his services. I clicked again.[1]

Interestingly, it turns out that the evaluation rubric for quality of care is based on "a physician's compliance to medical guidelines established by the medical community." That's pretty heady stuff. Or is it?

"We do not want quality healthcare as defined by the medical community."

Another mouse click led to the breakdown of the quality metrics. The quality-of-care guidelines include standards for specific conditions, such as asthma, etc., as well as adherence to (inter alia) vaccination schedules. And here's the rub: my wife and I do not agree with the current guidelines for treating asthma or scheduling vaccinations. And we have found a physician who accepts our opinion — to his statistical detriment. In these important instances, we do not want quality healthcare as defined by the medical community.

Now I have no issue with guidelines or ratings. They provide a means to understand the services that a given physician might provide. They are not perfect, but what is? And, more importantly, they are not mandates from government. So my wife and I can receive the healthcare we desire for our children in spite of the guidelines. We are free, so to speak, to find our concept of high-quality healthcare unimpeded by government.

Of course, healthcare is highly regulated and therefore not to be considered a truly free market. Nevertheless, it displays some aspects of freedom by allowing the consumer to exercise a level of choice.

Let us contrast the above with public education, setting aside for the moment the fact that public schools are an arm of government. First, the federal government mandates statewide standards for educational outcomes. Then the feds layer additional levels of compliance on top of those standards. The promise is that no child will be left behind. Behind what? Behind the standards set by government, of course. But who seeks the same standards as government, under all circumstances? I venture to say no one other than the members of the committee that approved the standards. And they probably don't agree with their own consensus opinion in all instances either.

Complete the move of healthcare from the free market to the authority of government and the guidelines become mandates. Healthcare providers will no longer be judged against various guidelines, with the consumer deciding whether to accept or reject a guideline based on personal preferences. No, government will mandate that all healthcare providers adhere to its guidelines — under penalty of law.

Many believe that government always provides the efficient solution. They believe this to be so since government-mandated guidelines remove the possibility of ineffective treatment. In other words, the treatment will always reflect the current consensus opinion of medical professionals acting as altruistic government agents. However, following the accepted medical guidelines does not guarantee health. In fact, many claims in healthcare are widely, and reasonably, debated within the medical field.

"Allow government to decide levels of medical risk — to socialize personal risk — and healthcare follows the same path of any socialized sector of the economy."

Guidelines are simply a consensus opinion. They are not correct for all circumstances, nor are they meant to be. While it is true that humans act — they employ scarce means in order to obtain specific ends, it is not true that all humans select the same means or the same ends — or even the same means for similar ends. And we are all better off for that.

In addition, humans do not respond identically to medical procedures. Similar to entrepreneurial profit and loss in a free market, each medical procedure has the potential to provide benefits as well as lead to complications. In decisions involving health and business, true freedom only occurs when the owner of the decision is the respective property owner — the patient or parent in the doctor's office or the entrepreneur in his business office.

Allow government to decide levels of medical risk — to socialize personal risk — and healthcare follows the same path of any socialized sector of the economy. This is apodictically true.

We are acting individuals with our own preferences. We are not automatons seeking to conform to an imposed definition of quality. Though the government may appear to be the safe solution, it is the siren enticing us onto the rocks.

I do not want to be forced to conform to someone else's guidelines. I want the healthcare I desire. Call it high quality or low quality; I could not care less. Simply allow me to make my decisions — informed or ill informed — based on my evaluation of the options. Only then am I free.

Note:

[1] Interestingly, our pediatrician rates high in the number-of-patients category. So we know for certain that he is providing healthcare that is sought by many parents. And that alone is enough reason to question his low metric for quality of care. Who better to decide quality of any product or service than the consumer?