Could doctors start behaving as they ought? As salespeople for their services and for products, who, at the end of the day, must convince customers (patients) to spend for those services? Maybe. At least it’s being discussed.

It’s not entirely doctors’ fault that the healthcare system is a completely dysfunctional market. It’s the entire nature of the healthcare system and in particular the role of government in creating perverse incentives in that system. Such perverse incentives include: requiring emergency room treatment to be administered if somebody shows up, granting massive tax breaks to health insurance costs, insurance regulation that requires certain treatments to be covered and fixes or limits what can be charged for treatments, and programs like Obamacare.

But doctors are one important part of the problem. They ought to be salespeople, first and foremost. Any craftsman or tradesman or professional, if they want to be successful needs to learn some art of selling. Lawyers, software engineers, financial advisors, plumbers, etc. Doctors are only different in that they sell health care, which, for all sorts of stupid reasons, people don’t think is a product nor functions in a market like every other product and service that has ever existed.

And part of the reason doctors are an important part of the problem is because they clearly don’t understand that there is a problem. From the article:

“There should be forces in society who should be concerned about the budget, about how many M.R.I.s we do, but they shouldn’t be functioning simultaneously as doctors,” said Dr. Martin A. Samuels, the chairman of the neurology department at Brigham and Women’s Hospital in Boston. He said doctors risked losing the trust of patients if they told patients, “I’m not going to do what I think is best for you because I think it’s bad for the health care budget in Massachusetts.”

Yes – doctors should be the ones concerned about the cost. As a salesperson, you don’t lose somebody’s trust if you prevent clear cost-benefit analysis of your products; you lose somebody’s trust if you lie, sell crap, or are a jerk. Amazon has my trust because they tell me exactly how much something is going to cost and tell me all of the benefits or disadvantages of the product (largely through completely uncensored, unregulated ratings and reviews from other buyers). Furthermore, the guy above is clearly thinking about the government’s budget, not the patients’. The disintermediated payer problem is perhaps the biggest problem in health care, at least with respect to health care functioning as a proper market.

And this:

Generally, Medicare is not supposed to consider cost effectiveness in coverage decisions, and other government attempts to do so are susceptible to criticism as rationing.

is a big issue and part of the exact reason why government should not subsidize health care. We should have doctors selling products to patients and patients more directly paying the cost. But IF government is going to provide insurance (Medicare) or subsidize cost or otherwise completely screw up the free market-ness of health care, then government ought NOT to ration care. The argument could be constructed like this:

1. Medical care should not be rationed (by a third party; that is, it should ONLY be rationed by the payer’s budget).

2. If the government is involved in medical insurance/care, then medical care will be rationed.

3. (conclusion) the government should not be involved in medical insurance/care.

I don’t see how you can argue that 2 is incorrect. You can certainly argue that 1 is not correct, but then you’re saying something like health care is a right. It’s not. It can’t be. Why not? Because then a whole lot of people become enslaved to those needing medical care and one person’s rights cannot – as proper rights – infringe upon another person’s rights.

And, there’s more, but I’ll stop here for now…(if you do want more, read Evolve, because this is what a lot of the book is about.)

-JD Cross