Consumer Focused Health

The massive controversy over caffeine levels of decaf reported in the NYTimes Well blog highlight that people can have massively different perspectives about the value of the same product, which is what makes economics so fascinating, and top-down regulation so hard.

The Well blog got a java jolt this week as nearly 300 readers debated the merits of decaf, caffeine and espresso. The coffee smackdown was prompted by my post highlighting a Consumer Reports article about decaffeinated coffee. The CR coffee sleuths found relatively high levels of caffeine in several cups of decaf sold by popular chains.

Decaf drinkers were grateful for the information, noting that stealth caffeine is cause for concern for people who are prone to migraines or other health problems.

No wonder I still fly when I drink those decafs…now I know.
— Posted by Lee

But caffeine lovers weighed in, saying decaf was hardly worth writing about.

What’s the issue here? … Who drinks decaf anyway?
— Posted by Rance Spergl

I’ve never understood decaf drinkers. I personally think decaf is a sin against the coffee gods. Why if you are sensitive to caffeine would you drink coffee anyway? Why not just switch to another beverage, that’s actually decaffeinated. Instead of whining OMG there’s caffeine in my coffee, switch to water (in reusable plastic containers with an organic lemon wedge of course).
— Posted by La Tosha

Personally, Decaf coffee makes about as much sense to me as nonalcoholic beer! Without the kick of caffeine, why bother?
— Posted by Chuck

As we can see, choice is important, and people often have strong opposing feelings about the same topic (hence the taboo on mixing dinner with politics in some circles). It is fairly safe to say that streamlining the “waste” of producing multiple lines of caffeinated drinks (from green tea to Red Bull) may reduce wasted administrative spend on caffeine delivery, but few are wont make that argument outside of health insurance.

Whats also important is that the choice be real– which is why you see all the outrage over caffeine in the “decaf” drink.

Applying this to medicine, when you’ve asked for one treatment, when you don’t get what you asked for, you’re upset. And when aware of choices, people often will choose different things (and place different values on them).

So why does anyone believe that one set of pre-defined cutoffs should limit our choice of health alternatives, and how do providers justify using their preferences in making recommendations to patients (rather than discuss alternatives and allow the patient to choose)?

Seems to me healthcare consumerism will require quite a mindshift…

Should formularies exist as absolute creatures? Should tiered pricing and choices become more of the norm (especially where trade-offs in medical devices or pharmaceutical classes can be significant)? Will consumers be able to choose up front doctors who share their same values in treatment (as docs tend to hit all nails with their one hammer).

What will a consumer-centered healthcare world look like?