Everything HR 3200

[Mokele]

But there's also a consequence to a culture of consumer level accountability that we don't have today, that can partially explain the lack of general knowledge. Although, I don't think our working knowledge of the human body and medicine is quite that bad.

 

In a survey in the UK, which has a MASSIVELY superior educational system, less than 50% of the populace could correctly locate the heart, even generally.

 

I've taught anatomy, both pre-med and medical school level, and in the former, even in students who're supposedly prepared, the level of ignorance is staggering.

 

The vast majority of the public does not have anything even remotely close to the level of knowledge needed to make an informed medical decision about even the simplest treatment. And if you ask that they learn this themselves, the results will be atrocious.

 

Hell, just look at the proportion of our population who think you can cure disease with freaking *water*.

 

But what about rotator cuff surgery? Carpal Tunnel? Knee replacement? Hip replacement? These are popular procedures, that I'm not an expert in, by any stretch, but I do feel I could assess the level of service I'm willing to pay for.

 

I can 100% guarantee that you do not have that level of expertise.

 

I don't have that level of expertise, and I'm teaching medical anatomy. I've dissected those joints in human cadavers with my own hands, and I don't know them well enough to make an informed decision.

 

For knee replacement, for instance, would you chose the current standard (cheaper and widely used), or the vastly more expensive new model? Now consider that using the older version, there's an almost 50% incidence of severe osteoarthitis within 5 years. Hell, you doctor may not even know that, since it's a fairly recent finding.

 

And remember, you're not just picking treatments, but rather choosing between doctors who offer different treatments - essentially, you're trying to chose which doctor is giving you a better, more informed opinion. The cheaper doctor may be avoiding something that's over-hyped, but also may just not be aware of the very most cutting edge of research. Can you tell which? Can anyone?

 

I think overall you're vastly overestimating both the amount of medical knowledge the average person has as well as how much is actually needed to make a truly informed decision.

 

And remember that, statistically speaking, half of the US population has an IQ under 100, and over a third has an IQ less than 85. Do they have enough knowledge to make these choices?

 

Flu jabs are one thing, but just about anything that beyond that level (which is where most of the actual expense is) cannot be realistically assessed by the average consumer.

[CharonY]

Also factor in the amount of disinformation floating around. Even in rather simple cases of vaccination.

[Pangloss]

I don't have that level of expertise, and I'm teaching medical anatomy. I've dissected those joints in human cadavers with my own hands, and I don't know them well enough to make an informed decision.

 

I'm not sure that making an informed choice about medical care is really about medical knowledge. I'm not an expert on cars, houses, or airplanes, but I think I can make an informed choice in buying one. I know it's not the same thing -- the standard is higher, no doubt.

[Mokele]

I disagree. You know a lot about cars and houses, having driven and lived in them most of your life. Maybe you can't re-wire a house or fix a transmission, but you at least have some functional knowledge.

 

Imagine your average joe on the street buying an airplane, however. Do they even have the slightest clue whether they want jet, prop, or turbo-prop? Do they know how to evaluate which controls they need and don't?

 

The fact is that the "perfectly informed consumer", upon which so many economic assumptions are based, does not exist, and is *especially* true when dealing with such a huge knowledge gap as between doctors and Joe Sixpack.

[ParanoiA]

I disagree. You know a lot about cars and houses, having driven and lived in them most of your life. Maybe you can't re-wire a house or fix a transmission, but you at least have some functional knowledge.

 

Imagine your average joe on the street buying an airplane, however. Do they even have the slightest clue whether they want jet, prop, or turbo-prop? Do they know how to evaluate which controls they need and don't?

 

The fact is that the "perfectly informed consumer", upon which so many economic assumptions are based, does not exist, and is *especially* true when dealing with such a huge knowledge gap as between doctors and Joe Sixpack.

 

Even an intelligently challenged market base causes changes in the market. When someone deals in a business of technical detail, they must provide education within their sales method. How many people knew what kBPs meant before MODEM manufacturers had to compete for speed? Our marketing department has to explain what a T1 is in order to convince a customer that they should upgrade to one.

 

This is the culture I'm talking about. When the consumer is the one that has to economize as well as receive the service, then we're back to tried and true market dynamics - the consumer gets courted however necessary to get his dollar.

 

Giving this a mere 30 seconds...I found this on a google search. In reality, most of us would spend a bit more time than that.

 

Minimally invasive total knee replacement involves the use of a smaller incision than the one used in traditional knee replacement. In the traditional method, the incision averages 8 to 10 inches in length. In minimally invasive knee surgery, the incision is only 4 to 6 inches long. Because there is less damage to the tissue around the knee, patients who undergo this procedure may expect a shorter hospital stay, a shorter recovery, and a better looking scar.

 

So, here, I have just learned something. Based on the cost of the two methods, and my resources, I can decide which one sounds better to me. Based on personal experience, word of mouth, any advertisements I may have seen, I may decide that St. Mary's hospital is a little more reasonable on price than St. John's downtown.

 

Now...how accurate is that? It may not be that accurate at all. Maybe St. John's is actually better on quality AND price, but my subjective experience subverts this fact. St John's will need to react to this and attempt to correct the public's impression of their hospital. They may roll out some advertising campaign, or offer some kind of specials, something to remedy the public's ignorance on their level of service and affordability.

 

I don't believe it's accurate to ignore the technically complex products and services we see in the free market and how that complexity is successfully dealt with everyday, and has been for years and years.

 

 

Further, I think much of your low expectation on the public is based on your particlar expertise in the subject in general.

 

This is exactly how I feel about homeowners and electricity. Idiots. They turn off their light switch, and then feel safe to change out the light fixture - much of the time, the hot wire is right there at the light fixture. They need to kill this back at the box.

 

To this day, I still get vendors - people who do this for a living, *charging* their customer big money - that ask me if their ISDN T1 circuit is wink start, or how many digits it's "outpulsing" - morons. The public has no earthly idea how complex the telephone network really is and in my mind they are in *no* position to make an informed decision about their service. It's amazing they can afford to be so ignorant.

 

But yet, they manage. I understand these things just on a deeper level than the average person, and thus they all appear tragically ignorant to me. In reality, they're not that stupid. Most of us are entirely ignorant about most everything. Think about it.

 

Consumer level pandering for economy and service has worked in every other market, no matter the mountain of technological ignorance. I find it difficult to accept that medical knowledge is the exception. It may be true, but I don't see any evidence to suggest that. Ignorance is quite an expensive commodity, certainly, but is just not impacting enough to keep market forces from working, in my opinion.

 

But that's all I got in the tank. You make good points on the matter, and both of us have made our case. You can have the last word.

 

It was good talking with you guys again.

[DJBruce]

Here is a really interesting interview where Jon Stewart interviews Betsy McCaughey, the women who supposedly started all the debate on the "death panels". She actually brought a copy of the bill and her and Jon actually debated the language of the bill. It was a really interesting interview and Jon really went at Ms. McCaughey, saying she was completely wrong in her interpretation.

 

Part 1 of the Interview

 

Part 2 of the Interview