I just read an interesting post by Seth Godin titled “The Choke Point”. Seth is talking about Facebook and LinkedIn and Google and warning us all that ‘Again and again, we see that if you’re not the customer, you’re the product. “Free” usually means, “you’re not in charge.” The race continues to be one for attention.‘.
It made me think about healthcare and especially employer provided healthcare insurance.
Healthcare insurance is usually not completely free (although at Microsoft, when I was there, it was), but even though we are paying a greater and greater share of the insurance premiums, we are fooling ourselves if we think that we are the real customer making healthcare purchasing decisions in a real market.
How much is your employer paying for your healthcare insurance – do you have any idea how much it really costs? You are not the insurance companies customer – the employer is. How much did your doctor charge your insurance company for your last office visit? Which diagnosis and procedure codes ended up on the claim submitted to the insurance company and how much was actually paid? Did you have any say in the matter? Of the $2.6 trillion spent on healthcare last year in the US, how much of that was spent “on” you? You are not even your physician’s real customer – the insurance company is.
The media is starting to peel back the curtain on the healthcare market and expose the alternate reality that it operates in. $100k for a knee replacement in the US vs $13.6K in Brussels – that is so utterly ridiculous that I’m at a loss for words (and that really is saying something!).
Could the reason that this alternate reality market was able to develop be due to the fact that the end-consumer of healthcare is not the customer – but as Seth put it, the patient is actually the product?
It is no wonder that nobody is spending any real money on prevention – that would de-value the product. If you take care of your joints when you are in your 30’s, 40’s, 50’s – then you won’t be worth $200,000 to replace your knees in your 60’s. Where’s the profit in that?
How the hell did we end up with such a mess?
mark feinholz - software, healthcare & stuff 
You are right that the patient is not the customer in health care. But be careful what inferences you draw from that. From a systematic point of view, that changes the incentives, and people trying to reform the system have been grappling with that for years. It’s one of the arguments for single-payer healthcare financing. But I think very few doctors (nowadays) go through the rigors of med school, internship, and residency for the money (there are easier, more lucrative fields). So the vast majority of them are still focused on the patient.
I enjoyed your blog.
Thanks for your thoughts Mike. I agree, physicians treat disease, that’s what they have dedicated their lives to doing – they are the good guys/gals and for the most part not the ones getting rich on the trillions of dollars spent every year in this crazy market. $100k in the US vs $3.6k in Brussels for a knee replacement – that’s the problem. I just can’t help but wonder: if consumers had to choose and purchase health coverage instead of it being handed to them by their employer – would that help shift the responsibility for health to the consumer and help lead to the behavior change necessary to slow down the steady march towards chronic disease (and joint failure)?