Bartering and exchanging…

There’s been a lot of attention to the comments of Sue Lowden, who is running as the Republican frontrunner for the U.S. Senate seat now held by Senate Majority Leader Harry Reid in Nevada. At a town hall meeting, when describing her alternative to the health reform bill that passed, Lowden talked about going back to the world where patients would “barter” with their doctor. In a follow up interview, she didn’t back down from this quaint notion, and in fact talked about “taking a chicken to the doctor.”

There have been Jay Leno jokes and other responses, including this video that sets her comments to music

Beyond the silliness of bartering with a chicken to the doctor, there’s also the issue of how many chickens it would take, especially for more advanced procedures. Some websites have been designed to make this point, including one that actually calculates the numbers of chickens various procedures, like a hip replacement, would cost.

But Lowden clearly meant what she said, and deserves the ridicule. But there’s a serious debate here that should not be overlooked. One is that some folks really do want to just go back to the good old days, as if medicine hasn’t advanced and gotten more complicated and expensive in the process. Harkening back to history isn’t a good way to deal with our current and future challenges in health care.

Let’s take away the (admittedly humorous) statements about “chickens” and even “bartering.” It is equally ridiculous to suggest that individual consumers are in a position to bargain with their doctor. Yet it is an article of faith among some politicians that the real solution to increasing health care costs is to shift the costs onto individuals, have them pay cash, which would “empower” them to bargain for a good price.

For those who raise the fear that reform would make health care like a trip to the DMV, it’s strange to argue that health care should really be more like a trip to a used car salesman. Not only would that be needlessly stressful to have to bargain (especially at a time when you were sick), but the individual has little market power. Those who have been the best at negotiating have been large purchasers, like big employers or CALPERS, that negotiate on behalf of hundreds of thousands of people, that have the staff wherewithal to examine the data, make comparisons, and challenge insurer statements.

This is a relevant debate right now. As part of implementating federal health reform, there are bills to set up a new health insurance exchange, AB1602(Perez) and SB900(Alquist/Steinberg), in the California legislature. It is critical that this new exchange use its bulk purchasing power as an “active purchaser,” to bargain on behalf of the millions that will get coverage through the exchange, for the best price and value.

So there’s two different visions. One is an exchange that negotiates for the best cost and quality. Another is to simply let any insurer sell anything, and let individual consumers fend for themselves, and get deal on their own, with chickens or whatever else–frankly, it’s less of a free market than a flea market, letting the buyer beware.

In this continued health reform debate, in Nevada and here in California, we shouldn’t be chicken in our efforts to defend consumers.

Health Access California promotes quality, affordable health care for all Californians.

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