Imagine for a minute you want to buy a car. There is only onedealership within a reasonable distance to a population. And whenthat dealership opened 50 years ago, they sold a quality car at afair price. Because they were the only ones, and they provided agood product, they became very popular and everyone in the areabought and serviced their car there. Because of the unending trust,and the monopolistic set up, as the dealership grew over the years,they raised their prices. After all, customers were not priceshopping, so how were they to know if they were being overcharged?One year, the dealership started using cheaper part suppliers, andlower wage mechanics, but again, there was no choice for theconsumer.

You see, when the customers of a business do not demand highquality and fair prices, it doesn’t really matterhow altruistic of a business you are, your quality will go down andyour costs will go up. And this is what has occurred in our healthcare system.

The U.S. is number one in cost (by far) and near the bottom ofevery measure in the industrialized world on quality and outcomes.And I believe this has occurred because the consumer (the patient,in this case) isn’t deciding where their money (or their healthplan’s money) gets spent based on quality services and fairpricing. Sure, we think we are going to a “good” hospital based onit’s reputation or marketing, but rarely do American consumers lookat actual quality metrics. Think of the amount of work and researchthat most consumers put into buying a refrigerator. They look atwarranty, size, features, online reviews, and fit and finish intheir kitchen. Do we look at even half that many metrics when itcomes to health care? What is the hospital’s readmission rate,infection rate, mortality rate? What about that surgeon’smalpractice history, average recovery times, mistake rate? And perhaps most importantly, do we ever take price intoaccount? We often fail to do this even when we have skin in thegame, as when we have a high deductible health plan, but assoon as we have met our out-of-pocket or think we may hit it thatyear no matter what we do, any shred of consumerism we had goes out thewindow.