Are Healthcare Economists Healthcare Experts?

Healthcare economists see numbers and money not patients and care.

Professional economists study markets and policy.  They do not lead businesses, serve customers or develop product.  Sure, some CEOs take economics in undergrad but need MBAs and experience before leading big companies.

Take Michael Decter for example.  He’s a Harvard trained economist, previous Deputy Minister of Health and seems to be kind and sincere.  If you ever hear him talk about healthcare, ask yourself, “Who does he think leads and understands healthcare?” (see ‘Does Money Buy Change‘).

Decter wrote a piece recently called Saving Medicare. He talks about using paramedics, community nurses, pharmacists and palliative care to save Medicare.

He interprets symptoms of Medicare malaise, pronounces a diagnosis and prescribes treatment.

A Panacea

To a child with a hammer everything’s a nail.

Economists whack at provincial spending and fiscal policy.  And so they should.

But like chubby toddlers with hammers, they look around for other things to hit.  They pummel clinics and hospitals.  They batter doctor patient relationships redefining them as costs and waste.  They wrap pudgy fingers about their favourite hammers and reshape access to care and who provides it.  Then the government, like a good parent, lines up new shiny targets for economists to attack: utilization rates, collective bargaining, policy reform…

Experts at What?

• Do economists run businesses?
• Do they lead hospitals?
• Do they build clinics or care for patients?

Then why do economists talk like experts on healthcare?

Economists rule in publicly funded medicine.  They’ve mutated medical care into discussions about money, legislation, policy and politics.

Economists train to observe and critique.  They expertly identify patterns and problems.  Even if we grant (generously) that economists correctly diagnose healthcare problems, that does not mean economists can accurately prescribe treatment.  Furthermore, there is no proof economists could operationalize their solutions without command-and-control legislation.

Top Down

Economists think high level and see patients as numbers, care as cost.  They generalize and offer idealized solutions necessarily top-down.  They invert healthcare.  Instead of starting with a patient and her doctor, Medicare economists start with governments and tax dollars.

They should use their expert skills to measure, model and predict.  Then they should be quiet.

Why, for heaven’s sake, do governments think they can run a $50 billion industry with leadership made of mostly economists, researchers and policy experts?

Medicine Redefined

Pundits see medical care as economic transactions instead relationships based on one party devoting themselves to meeting another’s need.  Politicians cannot imagine patients being cared for by anyone other than purely self-interested providers.  Bureaucrats cannot understand therapeutic relationships.

Doctors and patients need to take back medicine.   It requires continual effort to keep healthcare about patients and providers instead of policies and budgets.  On behalf of patients everywhere, physicians need to challenge economists’ diagnoses and treatments.  We need to challenge economists’ definition of healthcare.  Healthcare is about therapeutic relationships not anonymous economic policy.

Healthcare economists are not healthcare experts.  What do you think?

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