Is buying health care like buying a car? Should it be? Can it be?
Can patients be shoppers who research all the options for doctors, hospitals, medicines and procedures? Can they take their potential choices for a test drive? Kick the tires? Should price be a factor in their decisions?
President Bush would say yes, and is expected to argue in his State of the Union address tomorrow night that Americans would be getting more value for the billions of dollars the nation spends on health care if comparative shopping was part of the process.
His prescription doesn't address, though, the major source of expense, which is the relatively small share of the population who are very sick. And it would discourage preventive care and screenings - already too little emphasized in this country - that can save the big bucks of late-stage treatments for patients whose ailments are caught early.
In short, when Mr. Bush proposes to increase tax deductions for people who buy high-deductible insurance policies and pay for routine expenses on their own he is serving primarily the healthy and the wealthy instead of addressing the health care crisis consuming ever larger chunks of the federal and state budgets.
As with his proposal last year to overhaul Social Security, it appears Mr. Bush is more interested in promoting an ideological goal - in this case of shifting the cost and risk of health care from employers to individuals - than in tackling the enormous inefficiencies of a system that allows tens of millions to go without health insurance until they wind up in hospitals and nursing homes.
He's starting small, by increasing tax breaks for medical expenses, which will be attractive to middle-class families who currently must spend up to 7.5 percent of their incomes on health costs to claim a deduction.
Another Bush proposal for an expanded system of "report cards" on doctors and hospitals to help patients assess quality of care seems useful in any case.
But his package is based on the assumption that health care is so costly because patients consume far more services than they would if they were paying their own bills. While that may well happen in some instances, it is not the principal driver of health care costs.
In fact, discouraging people from getting routine care by forcing them to pay out of pocket for it means the tab is likely to grow larger when they reach an emergency room.
Making health care choices is not like buying an automobile - nor should it be. If a car shopper makes a poor choice and winds up with a lemon, that's tough luck. But when it comes to medical care, pooling risk, resources and buying power is the answer, not caveat emptor.
