Monday, April 12, 2010

The Republican Health Care Proposal: Bargaining/Bartering WIth Your Physician

Steve Benen writes about Sue Lowden's views on how to contain health care costs:

Lowden is a former state senator and chair of the Nevada Republican Party. She's also, according to nearly every recent poll, the favorite to defeat Senate Majority Leader Harry Reid (D) in November. Lowden is not, as one might imagine, a supporter of recent improvements to the broken health care system, and she was asked at a candidate forum the kind of policies she'd prefer to see. Among her proposals:

"...I would have suggested, and I think that bartering is really good. Those doctors who you pay cash, you can barter, and that would get prices down in a hurry. And I would say go out, go ahead out and pay cash for whatever your medical needs are, and go ahead and barter with your doctor."

I'm pretty sure she means not bartering but bargaining here, but that doesn't make the proposal any more realistic.

First, many patients are sick when they visit a physician. It's hard to get into a cheerful round of bargaining when you see things through a fog and your tummy hurts. It may even be hard to think clearly enough to bargain.

Second, when is it, exactly, that the patient is supposed to start bargaining? To do it when the bills are presented is too late, so my guess is that Lowden would insert the bargaining process somewhere in the beginning stages, before treatment has been provided. But that is very tricky, because the treatment itself might change if the price offered for it is lowered. The physician might spend less time, order cheaper tests and so on, and the patient would end up with a different product than the one the non-bargainers get.

Third, and related to the previous point, the total cost of the treatments may not even be known until later in the process. How is the patient supposed to get the information needed for skillful bargaining?

Fourth, and finally, the power asymmetry between patients and physicians makes this a ridiculous suggestion. The consequences to the patient of a bargaining attempt which fails may be having to find another physician, waiting for another appointment and so on. As a minimum, a failed attempt may anger the person who is supposed to treat you next. I don't see patients doing this much at all, just as I don't see people applying for janitor jobs at IBM negotiating their wages as if they were equally powerful bargainers.