In Health Care, the Market Mindset is Hard to Break
Eric Haas examines a new development in health care in America and how it is being discussed in the media.
A recent article in the San Francisco Chronicle, entitled A Profession is Born to Help People Navigate the Health Care Maze helps demonstrate that it can be hard to change our ways of thinking, even when they aren't working very well.
Cognitive science has demonstrated the power of mental frames. They are physically part of our brains, created through the configurations of our neural circuitry. Once established, the neural circuits do not change quickly. So, we think, mostly unconsciously, in certain ways and it's hard to break our habits of mind. As a result, we often solve new problems using versions of the same old solutions, sometimes piling one on top of the other. It's hard to teach an old dog's brain new ways of thinking.
This is certainly true in health care. In the U.S., we've been so accustomed to thinking about markets as the solution to everything that we think of health care as health insurance delivered by companies competing against each other in the marketplace. But care and insurance are not the same—ask the millions of under-insured people whose policies do not cover the medical treatments they need. As a result, they are suffering unnecessarily and dying prematurely. (My Rockridge Institute colleagues and I examined this in The Logic of the Health Care Debate.)
Further, we know that the insurance market itself is the problem: insurance companies operate to maximize profit and must compete against other health insurance companies to do so. The intense competition to make profit causes people to get poor treatment for two reasons. First, competition encourages insurance companies to avoid the people who need care the most. This is because the competitive insurance marketplace doesn't spread the medical risks and costs evenly among the companies. So health insurance companies avoid people needing medical care by refusing to cover them or by charging such high premiums that policies are unaffordable to millions of Americans. (I discuss this further in SCHIP and the Rigged Health Insurance Game.)
Second, even people with insurance often get poor care because health insurance companies make more profit by authorizing less care. Care is an expense that when minimized, increases profits. So, insurance companies have a strong incentive to deny care to policyholders.
Clearly, the insurance marketplace is the wrong way to try to keep Americans healthy.
But this doesn't mean that we don't keep hearing about new market solutions to solve the current market problems. Case in point, is this recent article in the San Francisco Chronicle. The article is about a new type of health care professional—the Health Care Advocate (HCA). An HCA "specializes in helping patient and their families cut through the health care bureaucracy to find the help they need." The article goes on to describe HCAs as a new and helpful innovation—"people are overwhelmed by health care and are seeking people to help them out with it." But it is likely an expensive one. Most insurance policies do not pay for HCA services.
From the point of view of framing, this is an interesting—and quite expected—way of thinking. Most Americans are accustomed to thinking of the health insurance marketplace as a "system" for providing care; however, health insurance companies are first and foremost profit-maximizing corporations. They protect their profits through an impenetrable collection of regulations and gatekeepers that sick people and their families cannot navigate when then need specialized and extensive care. This poor treatment occurs despite Americans spending more money per person on health care than any other industrialized nation in the world. Yet, the solution embraced in the San Francisco Chronicle article is for patients to pay additional money on top of their insurance premiums to an HCA to help them use the system the insurance companies have created. When you are thinking with a market mindset, then another market solution may be all you can muster. Market solutions simply make sense, even when experience and facts demonstrate their ineffectiveness.
The power of mental frames might be best summed up by a quote near the end of the article from Margalit Mathan, a mother using an HCA to help with her daughter's juvenile rheumatoid arthiritis.
"It's unfortunate we need it, but in the system we all live in right now, if you're dealing with something really complicated, I can't say enough about how helpful it is," Mathan said.
Rather than finding HCAs as another example of the failures of our current market-based health insurance system, the Mathan and the Chronicle article present them as a positive solution to a problem that seems to have arisen naturally, without cause. Mathan and the Chronicle appear to have a hard time thinking outside the market frame for health care. In this, they are similar to nearly every Democratic and Republican presidential candidate.
It is for examples like this that we at the Rockridge Institute contend that changing the way we think—our mental frames—must go hand in hand with changes in policy. Especially in health care.
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Socialized Mind
“In the U.S., we've been so accustomed to…”
While I applaud your work here and what RI is doing for the discussion, I disagree with the statement or rather your use of “accustomed” in how American’s think of health care or any other necessity of the public as a whole.
In my experience, the American mindset is more so “conditioned” by the healthcare industry, the government and MSM since the late 50’s, 60’s, early 70’s. American’s still conjure-up “domination” and “communist” when anyone speaks of “socialized” anything. Most do not realize that social services like Medicare, Medicaid, SCHIP, VA and the like is a system of “Socialized medicine”. And the for profit industry, politicians, our government certainly do not want the public to want a system such as this for everyone, regardless of the great need for it. No, they want to tap into this desperate market and exploit the needs of our call for restoration. And let’s call it what it truly is, all in the name of profit. Yes, the "free market".
Why do we continue to re-invent the wheel? We have a system that works and that we can improve upon for the benefit of all American’s in need of health care.
Most are already paying for it, but can’t use it, yet. It is Medicare.
We need to “turn up the heat” on congress, to bring forth legislation that already exist. It is HR676. Hold open hearings on it. What can be gained? You’ll hear who is really for national healthcare and who has only vestige interest.
Yet we stumble, fumble and hem haw around with, jacked policy, no that policy, no my policy is better, no my idea is ……etc. Flood the system, drowning out any real measure of progress. And nothing gets done. This is a tool that is used over and over by those with a vested interest in keeping the status quo.
If all the presidential candidates’ health care proposals are so great, why did they wait till now to introduce them? Hmmmmm. Those that are in congress have had ample time to introduce legislation for their policy ideas.
Watch out! Head for higher ground! Here it comes, America’s health care quandary solutions’ tsunami.
Current tsunami: Immigration.
New! Health Care framing
>changing the way we think—our mental frames—must go hand in hand with changes in policy. Especially in health care<
This could not be more true...every time not-for-profit health care comes up, the same old talking points come up as well. Socialized medicine where the government directs your health care and takes away your choices, of doctors, of treatments, etc. These talking points are constantly parroted by the MSM, and none of them bother to make the distinction that we already have a system that decreases our ability to make choices about our health care. It is called health insurance, for profit companies that are in business, not to help people, but to spend as little on people as they can get away with. They tell you what doctors are on their list, what hospitals they have made deals with, what drugs they will pay for, and they penalize you if you go to a different doctor, hospital, and refuse to pay anything if your doctor wants you on a drug they don't agree with, if you have any drug coverage at all.
I have been fortunate to have had experience with national health care in Canada and despite what we have been told, the majority of Canadians would not trade their health care system for ours. With everyone covered, the cost of health care is able to be kept down, not like our free market system, whioh, like most all free market ideas, such as trickling down, doesn't work for those who need it most. In Canada, I picked my doctor like most Americans do, referrals from friends, and the Yellow Pages. I never had to get "approval" for procedures like MRIs and bonescans like I do with my current insurer. My doctor decided what I needed, and that is what I got, as did my family. And believe me, with a toddler and another child born in Canada, I used the system often during the 6 years I was there. I saw the doctor, handed over my plastic card, and that was that. I never saw a bill, ever. Whether it was in the office, the emergency room, or the hospital after a 10 day stay after a C-section, no bill was ever sent. That scenario reminds me of something else. My husband has a card like the one we used in Canada, while it is paper not plastic, it works the same way. Yes, Medicare is what it is called, the most socialized American health care system that works much like Canada's. He isn't told what doctor to see, or what hospital to go to. I supposed the MSM doesn't see the similarities between the two. I guess all our elderly folks are just dirty socialists, right? And our fighting men and women and their families who are on Tricare, the military's health care program, also socialists?
We must change the debate in America, but it will take a lot of work, and may have to be done incrementaly. I hope that Rockridge can help making that change.