Market won’t fix Rx care

The letter I received shortly after my annual mammogram was terse and ominous: The doctor wanted me to schedule a diagnostic mammogram to clarify something slightly suggestive from the first test.

At that point, according to conservatives who push a “market-based” health care fix in which consumers take responsibility for cost control, I should have started to shop around for the cheapest diagnostic mammogram: $350, but you can’t get to me for two months? $400 if I want the test a month from now?

CYNTHIA TUCKER
MY OPINION

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Needless to say, I didn’t start looking for low-cost tests. Instead, I panicked and endured a couple of sleepless nights before I was retested. (All ended well; there were no signs of disease.)

Something tells me that’s the way many women react when confronted with similar news. We don’t pull out the sales circulars and start looking for the best deal. We want an immediate test result from a good radiologist.

Yet, some conservatives are so wedded to a simplistic reading of Adam Smith that they believe every problem can be solved with laissez-faire economics. They insist that health care costs have soared, in large part, because consumers don’t know what procedures cost. If patients could shop for medical services like they shop for flat-screen TVs, costs would drop, they say.

That logic simply doesn’t hold up. Individual consumers lack the skill, the time and the power to negotiate prices in the health care marketplace. Large groups do. That’s why large employers and insurance companies can negotiate prices with pharmaceutical companies, hospitals and physicians’ groups.

That’s what the federal government does with Medicaid and Medicare. Oddly, many in the GOP detest that, calling it government “price control.”

When the Bush administration pushed through a prescription drug plan for the elderly, congressional Republicans refused to allow the federal government to negotiate prices for drugs. The result was a boon for pharmaceutical companies.

But the larger problem with the logic lies in patient psychology: Our relationship with medical services is different from any other goods or services. Most of us choose our physicians for perceived competence and convenience.

And we purchase the services that they tell us will keep us well. Most patients, after all, don’t have medical degrees. If your cardiologist tells you that you need heart surgery, would you haggle over price? Would you want that responsibility?

Certainly, there should be knowledgeable groups keeping an eye on prices. And results. Many experts believe that we could cut down on health care costs, without sacrificing quality, by shutting down those services that are costly but don’t produce good results.

President Barack Obama has proposed pouring funds into studies to determine which procedures and medicines actually make patients better. The medical establishment would then be expected to use only those treatments.

But three senators — Jon Kyl (R-Ariz.), Mitch McConnell (R-Ky.) and Pat Roberts (R-Kan.,) — have introduced a bill to oppose using that research in calculating payments to Medicare and Medicaid. In other words, they want taxpayers to pay for treatments that don’t work. Unbelievable.

A research-based approach is much more likely to yield savings in the long run than expecting individual consumers to figure out which tests they should pay for — and how much they should cost. The unregulated marketplace is pretty good at adjusting prices on houses, cars, shoes and hotel rooms. Medical care? Not so much.

Cynthia Tucker, an Opinion columnist, writes Sunday and Wednesday. Reach her at cynthia@ajc.com.