Healthcare Appetite – Curbing Demand

increased-appetite-400We talk about patient choice.  We applaud patient-centric care.  Our society values autonomy above all other virtues.  But we squirm when we talk about healthcare appetite and curbing demand.

Should we curb our appetite for healthcare?

Can we curb appetite?

Are we fine curbing others’ appetites, just not our own?

People want more.

  • More food.
  • More clothes.
  • More stuff.
  • And more healthcare.

Free-Marketists say the invisible hand of the market will limit appetite.  Supply and demand naturally curb consumption.  But what about consumption based on need, not just want?

Medicare fundamentalists ration appetite with wait lists, regulations and bureaucracy. Red tape strangles appetite before it grows beyond the public purse regardless of torture-by-wait-list.

In the West, we believe more is better.  We do not espouse enough.  We do not believe in moderation.  We imbibe, work and play to the limit and sometimes beyond.  Restraint, discipline, delayed gratification and self-control belong to an old-fashioned ethic.

“Use it up. Wear it out. Make do or do without.”

Restraint made sense in wartime; everyone rationed to protect property and country. But not now.

Medicare dawned on the ashes of World War II. Citizens knew rationing.  They remembered wheat rations and ‘patriotic foods‘.  25% of Canadians were rural in the 1960s, with less convenient access to healthcare.  Today, most Canadians live in cities with better access to modern (expensive) care. (see Statscan here and here).

As 1940s parsimony becomes ancient history, we can expect appetite for healthcare to get bigger.  Our system has “no brakes“.

Healthcare Appetite and Patient Choice

Patients need an incentive to consume less, or payers will ration care.  Incentives imply choice.  Choice implies patient control.  Control must include responsibility for costs , or costs will sky-rocket.

Medicare fundamentalists believe patients are too stupid to be given control over anything, especially their health.

Some Medicare zealots realize that eliminating choice and rationing care smacks of totalitarianism.  In response, they promote soft paternalism or libertarian paternalism. They believe we should create a society that makes it easy for people to make wise choices.  Master planners should make it very hard for common people to choose what utopian designers have decided are bad choices.

Most of us find unrestrained appetite repulsive in others but invisible personally.  Are we mature enough to discuss appetite and restraint or will we leave it to the state to define limits for everything?

“The more corrupt the state, the more numerous the laws.”  – Cornelius Tacitus

We need to discuss our opinions about choice, appetites and limits.  If we do not, choice will be removed by the state.  Power will be given to (or taken by) a few who place arbitrary limits on everyone.  Is that the kind of society we want?

 (Photo credit: health.com)

Physicians’ Rules vs. Patient Freedom

cma_lgThe Canadian Medical Association ended its Annual General Meeting in Ottawa today.  After pages of motions, speeches and procedure, I noticed:

Doctors like rules.

They want rules, guidelines and policy to drive change.

  • Is that because physicians are paternalistic and think everyone else too stupid to decide without a rule to follow?
  • Is it because Canadians prefer rules and doctors just follow culture?
  • Perhaps governments listen when citizens ask for rules and guidelines?

Controlling Innovation

New ideas grow in clear soil.  Disruptive innovation breaks rules and paradigms.  Guideline-makers scramble to keep up with new ideas forcing them into new guidelines.  Guidelines support enforced conformity.  Innovation, by definition, grows outside rigid controls or breaks rules to generate new things.

Innovation resists control.  Progress requires freedom.

Loving control

CMA delegates spent 3 days asking for controls and rules on everything from smoking pot to smoking wood stoves.  Delegate motions add up to a long list of things doctors oppose or want controlled.  Very few motions called for freedom.

Physicians supported freedom in affirming doctors’ right to not perform euthanasia if it became legal.  Delegates support doctors’ freedom.

A great society

What will give us the best country possible?  Do we get the best society by crafting dozens of rules about things we oppose and legislating things we approve?  Do we get the best society by continually shaping towards a vision, a utopian dream?

What other countries have tried pursuing dreams of perfection?  Do citizens have better lives in countries with more control, more rules?

Good Intentions

Physicians entered medicine to help patients.  Doctors spend their lives telling patients what they believe will benefit patients.

Governments politicate to help citizens.  Governments make rules they think will benefit citizens.

But patients can ignore doctors’ advice for healthy living.  Citizens cannot ignore the government’s rules. What seems moral and right to advise at the bedside is totalitarian if imposed by the state.

Forcing Good Health?

Canadian physicians petitioning government for rules (often) unwittingly promote a specific political philosophy.  The Canadian Medical Association must consider the politics it unintentionally promotes by seeking legislation for good intentions.

Physicians uphold patient autonomy far above the best medical science.  Doctors might consider whether their love of rules and legislation is an affront to patient freedom and autonomy.  Are we promoting:

Ideas so good they have to be mandatory?

 

Informed public policy?

Health Minister Rona AmbroseRona Ambrose, then federal Minister of Health Canada, spoke to several hundred doctors at CMA annual meeting in August 2014.

Facts must guide public policy.  We know medicine is an art and a science, but we need science to guide public policy.” (not exact quote)

What did she mean? Why say it?

  • Only facts matter?
  • Docs are all logical positivists?
  • Science matters more than any other source of knowledge?

Indeed, physicians tend to elevate scientific validity far above information from any other “-ology”; psychology, sociology, history, law, economics… Putting science above and before all else is scientism.  Scientism sees medicine as a technologic endeavour.  Medicine becomes nothing but a technological product.

Bureaucrats know how to control technological products.

“Where ends are agreed, the only questions left are those of means, and these are not political but technical, that is to say, capable of being settled by experts or machines, like arguments between engineers or doctors. That is why those who put their faith in some immense, world-transforming phenomenon, like the final triumph of reason or the proletarian revolution, must believe that all political and moral problems can thereby be turned into technological ones.  That is the meaning of Engels’ famous phrase…about replacing the government of persons by the administration of things”

– I Berlin 1958 in “Two Concepts of Liberty

The doctor-patient relationship defines medicine; a relationship struck to help patients in need.  Medicine needs to articulate what medicine is.  Saying medicine is nothing but a science applied with artistic care will not do.  Medicine is much more.

Informed Public Policy

If physicians define medicine as nothing but a technological product then bureaucrats will give us an administration of things.  We need to give federal ministers reasons to look for something more to guide public policy.