We are a commune of inquiring, skeptical, politically centrist, capitalist, anglophile, traditionalist New England Yankee humans, humanoids, and animals with many interests beyond and above politics. Each of us has had a high-school education (or GED), but all had ADD so didn't pay attention very well, especially the dogs. Each one of us does "try my best to be just like I am," and none of us enjoys working for others, including for Maggie, from whom we receive neither a nickel nor a dime. Freedom from nags, cranks, government, do-gooders, control-freaks and idiots is all that we ask for.
Patients are not consumers and physicians are not "providers": they are in a professional relationship of extremely personal and intimate content, in which judgement and individualized attention and care are required. Mutual trust and committment are key, and that is what Krugman wants.
On the other hand, Krugman would like us all standing in lines in government clinics. I think Krugman is a mixed-up person.
The new paradigm will be harder on those still enamored with the old tropes. The coming changes will make the recent tsunami's look like small swells. The customers will adjust quite well. The Providers particularly the older ones will not. Retirement will beckon for most, if not all.
Once upon a time it was true that physicians had a special professional relationship with their patients. Increasingly that paradigm is a rare result. For at least the past twenty years my own medical care has been a series of short-term treatments by busy specialists, with no office visit ever exceeding twenty minutes. It's checklist medicine these days, a quick matching of reported symptoms against a few subcontracted blood tests or high-tech imaging reports. If the numbers call for another billable service, they'll be glad to schedule something. Otherwise, good luck getting any reading or interpretation of the results.
Heck, my family doctor can hardly be reached anymore after navigating the office voicemail system and the officious nursing staff. He's too busy to keep my appointment for my annual physical, though Nurse Ratched was kind enough to offer me a reschedule with a Physicians Assistant in a mere four months.
Face it, modern medicine is a business. It could stand some commercial-type best practices sharing to improve the customer experience, same as any other consumer business.
Linked at http://punditpress.blogspot.com/2011/04/paul-krugman-is-complete-and-utter-dolt.html
Medicine has always been in part business. The ol' family doc still had to collect his/her bills in the days before insurance.
Patients may not be "consumers" in the examining room but they certainly are (in part at least) when shopping around (looking around? getting advice?) for a doctor. Or for an insurance policy.
Perhaps the problem is that the business has changed. Individual doctors generally are no longer the agents on the business end of things. hard to say what the solution to that might be. while Obamacare will make things worse, they have not been going all that well in recent years anyway...
It really depends on what's wrong with me. If it's something obvious that won't get better on its own, like a UTI or a laceration requiring stitches, I'm an ordinary consumer seeking efficiency and the lowest price for the greatest convenience. If it's something mysterious (is that mole a cancer? Is that pain a backache or an aortic aneurysm?), I want the most skilled and dedicated professional I can afford. In neither case do I want a rushed, dispirited bureaucrat.
It's the same as for legal services. To close a routine real estate transaction, Joe Blow the reasonably competent guy with a cookie-cutter volume business and low prices will do. If the NLRB has just sued me for opening a new plant in South Carolina, I want the equivalent of a fanatically dedicated heart-transplant surgeon.