Article archive / October 2017
Originally published: . Volume 8, No. 10. Source pages: 2.
Archimedes and I have an on-going debate about how social exchange systems self-correct.
He’s a true believer in the free market––over time, he says, the bad product or bad service will be eliminated. The customer will choose what is best. And, any outside attempt to intervene on the supposed behalf of the consumer, especially intervention by government or third-party do-gooders, will foul up the system and make things worse in the long-run.
I essentially agree with this but accuse him of being a purist of the Milton Friedman fan club variety. I say he is not thinking of the free market but of the perfect market, the clean as the driven snow market, full of white hats and black hats and no gray hats. The consumer I say to him must be all knowing, prescient, telepathic, clairvoyant and with an IQ of at least 150.
He yawns and goes back to Free to Choose. I turn the volume back up on Star Trek.
We never quite reach a consensus but often I demand for him to tell me just how many two-year olds have to die from dangerous baby cribs before he’s willing to regulate the market and then he asks me how and what higher power is going to make the decision which baby crib is defective. And, he warns that the method will result in dead babies now and even more dead babies in the long term.
Of course I’m a scientist (or like to think of myself that way to feel superior about something or another) and say, “With good research we’d know!” Of course that’s a lie because it is not possible to know everything before we know it. Usually we don’t even know the right questions to ask. Life is messy.
It is a month like the last one that reminds me how very little control any of us actually have, adding to Archimedes’ depressing (or is it uplifting) philosophy.
Even so, and accepting that social exchange can never be perfect, there are some elements that are “must haves” if the exchange system is going to even have a chance of working. They are:
1) Knowledge: The consumer must be completely informed about what is known about the produce or service. Any attempt by the vendor to hide information or manipulate facts is prohibited (usually called fraud). Complete, relevant knowledge is required.
2) Awareness: The customer or consumer must understand the consequences of his/her selection decisions, the long-term costs and benefits.
3) Choice: The consumer must have the power to select between alternatives, so that some vendors are rewarded and others are not. This helps connect to responsibility and just to remind us, motivation for the customer and vendor.
4) On the vendor side of the equation, vendors are prohibited from lying, cheating, stealing and so forth, either consciously or unconsciously.
There are lots of other variables and issues, but these are a good start for this lifetime.
The current heartbreaking crisis in opioid prescribing is nowhere close to meeting system requirements. The healthcare industry is so far off at this point that––I really hate to say this––there is no hope.
If we were in the Wild West and this healthcare system was our horse, we’d have to just shoot it.
We are 50th in the 55 industrialized nations, medical mistakes are the 3rd reason we die, and we now find that manipulation of the pain treatment marketplace enriched drug companies and addicted a lot of new people and is even killing so many that the mortality figures are changing.
So many elements of the system are in bed with other elements of the system that it looks like a scene from a daytime soap opera. A conflict of interest occurs when a physician, hospital, insurance company, or drug company cannot improve care for a patient AND at the same time, improve its own revenues. These conflicts are everywhere in this system, they are the rule rather than the exception.
It is every man for himself, every woman for herself, –– the consumers are on their own.
Caveat emptor.
This article is part of a historical newspaper archive. Read the original issue for its original layout, photographs and graphics.