Consumer culture

This BLOG picks up where the last one left off - discussion of all of us as "consumers of health care ". I started wondering what does being a "consumer" mean. I had heard the discussion about how we are becoming/have been a "consumerist culture". Then I started wondering if everybody is really a "consumer of health care" and if we should indeed approach the debate on health care that way. So of course I went to Dictionary.com and got a formal definition of "consume". Here it is:
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consume
c.1380, from L. consumere "to use up, eat, waste," from com- intensive prefix + sumere "to take," from sub- "under" + emere "to buy, take" (see exempt). Economic sense of consumer (opposite of producer) first recorded 1746. Consumerism is from 1944 in the sense of "protection of the consumer's interest;" modern sense of "consumption as an economic policy" is from 1960.
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I was struck by the base of the word is "to buy, take, use up" in an intense manner. When I go to the doctor, do I really "consume" his services? I feel intensely uncomfortable with that characterization. Consumer/customer is supposed to be the king. The goods and service providers aim to please the customers/consumers and give them what they want. Is that a correct model to adopt in health care setting? More importantly what is the role of the consumer/customer in determining the utility/effectiveness/value of the transaction? In most ordinary cases the utility/effectiveness/value is very largely if not completely determined by the producer or the entity delivering the service. The taste of the food, at the first level, does not depend on your actions. What is required on part of the consumer/customer are some basic actions - chew the food and swallow. Similarly in case of travel, it is completely incumbent upon the airline/railway/bus companies to ensure safety, comfort, timeliness of the journey.

In case of health care, the situation couldn't be more different. In most if not all cases, consumers/customers play a vital role in the outcome - restored health and functionality. The consumers/customers have a very significant role in determining the efficiency and cost effectiveness of the enterprise. So what does it mean in the case of health care that "consumer focused culture" or the health care industry that says "customer is always right"?

One specific case captures this issue: I heard a news report about Nexxium (the acrid reflux medicine). It is a powerful medicine (proton pump inhibitor that completely stops acid production in the stomach. The report talks about the severe side effects when the medicine is stopped. There are many lifestyle changes that are found to be quite effective in managing the acid reflux. However many people may find those "hard" and "not acceptable" especially when there is a pill they can take and their insurance pays for it and they can continue living as before without the pain and discomfort. Same things can be said about hyper tension, cholesterol, diabetes. It is clearly what the customer wants. Is that what the doctors and insurance companies should give? If we accept a certain model of transaction between health care providers and customers, then this is indeed what should happen and as a matter of fact is happening.

Some people may say I am talking about a paternalistic view of health care providers. May be that is what I have in mind when population at large continues to behave like juveniles! Another analog that I will expand on later is the education system. If the teacher considers a student to be the customer/consumer then it is clear that most of the customers/consumers want grades without homework and exams. Is that what the teachers should provide?

If one does not want a paternalistic health care system, then they should act like adults and accept consequences of their actions. A chain smoker who develops lung cancer or COPD should be (may be) given palliative medication to "take the edge off the pain somewhat" but should be allowed/required to face consequences of their actions. Same goes of obese people suffering from many maladies that come with their behavior, or for alcoholics who develop cirrhosis of liver.

Are we as a society ready to take these actions? If not, then we have no right to expect to demand a "consumer-oriented health care system"!