Populism wave hit healthcare before politics

The political pundits say they didn’t see it coming. Donald Trump is running roughshod over the Republican presidential field by laying rhetorical waste to every institution in sight: the White House, Congress, the media, corporations that export jobs and hedge fund operators, not to mention women. And on the Democratic side, self-described democratic socialist Sen. Bernie Sanders (I-Vt.) is speaking to enormous crowds about how the nation’s financial and political giants are taking advantage of average Americans.

{mosads}Instead of preparing for an expected reprise of Bush versus Clinton, reporters and columnists are marveling at the rise of this new populism across the land and wondering just how it happened.

If they had paid closer attention to what’s happening in the nation’s healthcare system, they would have seen it coming. The electorate is angry; so are the e-patients.

For generations, the relationship between patients and healthcare institutions was defined by passivity from the former and unquestioned authority assumed by the latter. Patients did what their doctors told them, assumed every treatment decision was in their best interests, paid what they were told to pay and didn’t presume to challenge the system because they didn’t have the knowledge or information with which to do so.

In healthcare, however, we started seeing a consumer uprising a few years ago, powered by the Internet, information technology and an innovative consumer sector — and it’s continuing to grow in intensity. We’ve been witnessing a swell of populism in healthcare on at least three fronts:

We demand control of our own data. The idea that doctors can examine us and take our blood, that hospitals can put us in MRI tubes and send us into operating rooms, and we never see the actual records of those interactions, is rubbing patients the wrong way. A recent survey found that over half of those patients with chronic conditions like diabetes, hypertension or heart disease believe they don’t have control over their own health data, but 87 percent — in other words, virtually every patient who has regular contact with physicians and hospitals — want that control.

This indicates that the age of passive acceptance of whatever the healthcare establishment tells us and wants us to know is rapidly receding. Information is power, and consumers are demanding a significant degree of control over their own diagnostic and treatment decisions.

We want healthcare access on our terms, in both convenience and price. Waiting for the primary care physician to find time to fit you in for a checkup? Pay whatever you’re asked to pay, because it’s not as if you can comparison shop among healthcare providers for a better price? Today’s medical consumers are saying, “forget that.” Instead, they’re taking their business to the local drugstore.

A report on retail health clinics — those found in your local Walgreens or CVS stores, for example — by the Robert Wood Johnson Foundation and Manatt Health found that the number of such clinics in the U.S. has increased by 900 percent in less than a decade and patients are utilizing them more than 10 million times each year. The reasons for this growth are not surprising: the retail clinics stay open longer, you don’t need an appointment and they cost less.

For the first time in the history of healthcare in this country, we’re seeing consumers use their buying power to dictate a sea change in the way care is delivered.

We approach medicine as consumers, not subjects. Even though the popular consumer review site Yelp started allowing its users to rate and review health professionals in 2004, more than half of the reviews on the site have been written in the last two years. In days past, if patients received subpar treatment from their doctor or hospital, they simply had to live with it. Now, though, we can communicate our indignation and unhappiness — or, of course, our approval of services rendered — to fellow consumers via online forums, and we’re not hesitating to do so. The medical profession may not like this, but it’s inevitable that this Internet-empowered consumer populism will make doctors, nurses and office staffs more attentive to those whom they treat.

So, yes, a robust strain of populism, for better or worse, is finding its way into American politics, embodied in the Trump and Sanders movements. This seems less a novelty, though, than a natural progression. The electorate is demanding that those who control their laws and their money start listening to them. E-patients are demanding that those who have access to their health data stop hoarding it. The people have spoken, and they are angry.

Business as usual no longer works — in politics or in healthcare.

Strongin is founder and creator of Disruptive Women in Health Care.