In yesterday’s New York Times Magazine, David Leonhardt’s interview with President Obama revealed his perspective on the role of consumers in a reformed health care delivery system. Leonhardt asked Obama how people “will experience medical care differently on the other side of health care reform.”

First, Obama answered generically — from a policy perspective:

“First of all, I do think consumers have gotten more active in their own treatments in a way that’s very useful. And I think that should continue to be encouraged, to the extent that we can provide consumers with more information about their own well-being  — that, I think, can be helpful.”

Obama definitely understands the basic premise that engaging consumers more actively in care management is critically important for improving the effectiveness and efficiency of the health care delivery system.

That made his more personal comments — reflecting his own experiences as a patient and a caregiver — even more interesting.

“I have always said, though, that we should not overstate the degree to which consumers rather than doctors are going to be driving treatment, because, I just speak from my own experience, I’m a pretty-well-educated layperson when it comes to medical care; I know how to ask good questions of my doctor. But ultimately, he’s the guy with the medical degree. So, if he tells me, You know what, you’ve got such-and-such and you need to take such-and-such, I don’t go around arguing with him or go online to see if I can find a better opinion than his.”

It was interesting that Obama reports on what some might view as a fairly traditional view of the hierarchical relationship between doctor and patient. Obama may be like the majority of Americans in this respect. He certainly believes that consumers should be empowered and engaged, but he believes that the reality of the existing health care delivery system renders that model somewhat infeasible, at least in many cases.

What I think is unclear from the interview is whether Obama is satisfied with that situation — that is, he doesn’t want the responsibility of that decision making — or he is frustrated that the system doesn’t provide him with better resources.

Obama further explains at least partially how government can play a role in helping to improve care delivery.

“And so, in that sense, there’s always going to be an asymmetry of information between patient and provider. And part of what I think government can do effectively is to be an honest broker in assessing and evaluating treatment options. And certainly that’s true when it comes to Medicare and Medicaid, where the taxpayers are footing the bill and we have an obligation to get those costs under control.”

Obama believes (and he goes on to explain considerably more detail on this subject) that part of the solution for supplier-induced demand of health care services is for the federal government to do comparative effectiveness research (CER) in a non-politicized environment. Once again, though, it’s not exactly clear how Obama believes CER should be communicated to lay people. He no doubt believes in some level of shared decision making — using CER to facilitate more evidence-based and informed discussions between clinician and patient.

He suggests later in the interview that there should be some degree of communication directly with consumers about CER findings when he says, “…If a provider is pushing [one medication approach] on you, then you should at least ask some important questions.” Hopefully, we’ll find out more about how he and HHS think this should be done in the next couple of months.

This entry was posted on Monday, May 4th, 2009 at 9:10 am and is filed under Inside the Beltway, Participatory Medicine, The New Health Care Consumer. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.