High-deductible health policies and Rep. Paul Ryans budget plans for Medicare both assume that health costs can be kept down by treating patients more like consumers.

The thought is that those of us with insurance are disconnected from the price of our health care since we usually dont pick up the bill and that having more skin in the game would make us more fiscally careful about the goods and services we use. As one commenter, SLC, wrote in response to our recent post on high-deductible plans, Let consumers take charge and be responsible, and stop assuming they are incapable of rational decisions.

In his NYT column today, economist Paul Krugman takes issue with that notion of patient as consumer, saying health care isnt the same as other transactions:

Medical care, after all, is an area in which crucial decisions life and death decisions must be made. Yet making such decisions intelligently requires a vast amount of specialized knowledge. Furthermore, those decisions often must be made under conditions in which the patient is incapacitated, under severe stress, or needs action immediately, with no time for discussion, let alone comparison shopping.

Krugman says the professionalism of physicians, and the relationship they have with their patients, is eroded by turning health care into a transaction in which doctors are just providers selling services to health care consumers.

But if theres no incentive for physicians and consumers to cut down on those aspects of medical care that dont provide good value for money, how will health costs ever come down? Health Blog readers, any ideas?

Update: Just found this post on the Movin Meat blog (by an ER doctor and administrator) which also addresses this patient/consumer question.

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