History and Health Policy in the United States: Putting the Past Back In

By Rosemary A. Stevens; Charles E. Rosenberg et al. | Go to book overview

Nancy Tomes


Chapter 4
Patients or Health-Care Consumers?
Why the History of Contested Terms Matters

Since the 1980s, the use of the term health-care consumer as a synonym for patient (along with its doctor analogue, health-care provider) has become commonplace in the United States. For many observers today, especially physicians, this linguistic transformation has come to represent the worst consequences of American medicine's growing market orientation. As one doctor quoted by the columnist Ellen Goodman quipped, "Every time a patient is referred to as a health-care consumer, another angel dies," while another cited by William Safire observed, "The managed-care organizations call people consumers so they don't have to think of them as patients" (Goodman 1999; Safire 2000; emphasis in original). Such visceral dislike of the term health-care consumer reflects not only the loss of physician autonomy that has accompanied the coming of managed care, but also a deeper sense of violation: a conviction that applying the base language of the marketplace to the sacred realm of the doctor-patient relationship is fundamentally wrong.

In the introduction to his 1998 book Some Choice, George Annas makes a strong case against referring to patients as consumers on just such grounds. Market models of competition do not work when applied to health-care choices, he argues, "because patients are not consumers who pick and choose among physicians and treatments on the basis of price and quality." The legal principles derived from the United States Constitution and the Bill of Rights are a surer foundation for protecting patient interests than any economic theory, Annas suggests; it has been in the courtroom and the legislature, not the marketplace, that entitlements to informed consent, privacy, emergency care, and the like have been most effectively secured. In contrast, consumer rights

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