Imagine for a minute you want to buy a car. There is only one dealership within a reasonable distance to a population. And when that dealership opened 50 years ago, they sold a quality car at a fair price. Because they were the only ones, and they provided a good product, they became very popular and everyone in the area bought 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 price shopping, so how were they to know if they were being overcharged? One year, the dealership started using cheaper part suppliers, and lower wage mechanics, but again, there was no choice for the consumer.

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

The U.S. is number one in cost (by far) and near the bottom of every 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 health plan’s money) gets spent based on quality services and fair pricing. Sure, we think we are going to a “good” hospital based on it’s reputation or marketing, but rarely do American consumers look at actual quality metrics. Think of the amount of work and research that most consumers put into buying a refrigerator. They look at warranty, size, features, online reviews, and fit and finish in their kitchen. Do we look at even half that many metrics when it comes to health care? What is the hospital’s readmission rate, infection rate, mortality rate? What about that surgeon’s malpractice history, average recovery times, mistake rate? And perhaps most importantly, do we ever take price into account? We often fail to do this even when we have skin in the game, as when we have a high deductible health plan, but as soon as we have met our out-of-pocket or think we may hit it that year no matter what we do, any shred of consumerism we had goes out the window.