I am outsourcing this one. First to take a crack at the Princeton don . . . Will Wilkinson:
SOMETIMES people believe something so patently ridiculous, so detached from evidence and good sense, that it is more useful to diagnose it than to debate it. For example, the New York Times’ “Room for Debate” forum has been featuring an interesting discussion of the psychological principles underlying the widespread conviction that Barack Obama was not born in the United States, despite ample evidence to the contrary. While “birthers” are in my opinion richly deserving of such treatment, this sort of psychologising diagnosis of strong political conviction often serves as a cheap, supremely condescending trick for pathologising and thus dismissing those with whom we disagree. A good deal of work on the psychology of conservatism is like this. The motivating question, “What the hell is wrong with these people?” takes it for granted that there is something wrong with “these people”, and thus that disagreement with them is based not on a reasonable difference of opinions among intelligent people of good will, but rather on some sort of deep-seated defect of character or cognition in the “other” insusceptible to correction through civilised discourse.
It is in this dismissively diagnostic spirit that I would like to approach Paul Krugman’s latest column. He writes:
Here’s my question: How did it become normal, or for that matter even acceptable, to refer to medical patients as “consumers”? The relationship between patient and doctor used to be considered something special, almost sacred. Now politicians and supposed reformers talk about the act of receiving care as if it were no different from a commercial transaction, like buying a car—and their only complaint is that it isn’t commercial enough.
What has gone wrong with us?
Let us ask this, instead: What has gone wrong with this celebrated economist such that he has come to believe that something “has gone wrong with us” if we have come to conceive of those who buy medical services from those who sell them as “consumers”, which is what they are?
I found it very odd to see Paul Krugman complaining that “patients are not consumers” as if “consumer” were some sort of horrible, low-status role that should never taint the sacred realm of health care. In my economics classes, “consumer” was not a value judgement; it was a descriptor. A consumer is someone who consumes, just as a producer is someone who produces and a distributor is someone who distributes. So I was a bit befuddled to see an economist arguing that “The idea that all this can be reduced to money — that doctors are just “providers” selling services to health care “consumers” — is, well, sickening. And the prevalence of this kind of language is a sign that something has gone very wrong not just with this discussion, but with our society’s values.” Patients consume health care resources. Providers provide them. And the system through which labor and resources are allocated in our society remains money–an arrangement that I’m pretty sure that Paul Krugman doesn’t want to change.