AS AN ANONYMOUS but perceptive comedian once said, "Money talks, but all mine ever says is goodbye." The healthcare industry
has been saying the same thing since long before managed care arrived on the scene, so it's no surprise that its less-than-sparkling
financial history has led some experts to look for solutions that have nothing to do with economics.
What might be surprising to some is that one of this movement's greatest champions is Princeton University's Uwe E. Reinhardt,
PhD, James Madison Professor of Political Economy at the Woodrow Wilson School of Public and International Affairs.
"We economists don't understand anything but dollar signs and think that people will behave like Pavlovian dogs. "
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"We economists always think that waving money under peoples' noses will make them behave according to some theoretical script,"
he says. "But we've tried that with healthcare for decades and it hasn't worked. Healthcare isn't just about financial incentives;
it's also about anxiety, fear, habit, guan-xi—a Chinese word that, loosely translated, means 'family or business ties'—and professional pride. We've neglected to study
the impact that human behavior has on the system, and I don't think we can do much to improve it unless we address the non-economic
dimensions of healthcare issues."
For example, imagine that a physician must refer a patient to one of two surgeons. The first has superior quality (as reported
by an accredited industry organization) and the second is the referring physician's weekend tennis partner or brother-in-law.
On paper, the choice is clear-cut; in reality, it's a nightmare for the referring physician. Helping to identify strategies that motivate people to make proper decisions is an area in which sociologists could prove
invaluable, Reinhardt believes.
However, knowing what healthcare choice to make isn't a very useful skill to the 43 million Americans who have no coverage.
That's why Reinhardt says that having some level of coverage should be mandatory.
"Once such a law is passed, the next step would be to put into place a system that would allow individuals to buy policies
efficiently," Reinhardt says. "But people will have to become more responsible for their own health, and there should be penalties
for those who don't."
He points out that in Holland, for example, people who go to the dentist with a cavity are covered only if they have kept
up-to-date with their check-ups and cleaning. Those who didn't go to their regular check-ups and neglected preventive care
must pay a portion of the charges.
"At its best, American healthcare is unrivaled in the world. But it always amazes me what we put up with in healthcare at
its worst. "
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If that concept sounds familiar, you probably are thinking of the ill-fated plan that the Clinton administration proposed
in the mid-1990s.
"I think that the core of what they proposed was an excellent idea," Reinhardt says. "Mark my words: We will rediscover the
Clinton health plan."
Dollar signs Of course, money is and will continue to be a very powerful motivator for people, but it's a tool that must be used more like
a scalpel than a sledgehammer.
