I have often found myself disagreeing with my former college colleague John Stossel, the libertarian voice of Fox television news. The first time was probably in the fall of 1968 when I was the chairman (or top editor) of the Daily Princetonian and Rick Stossel (as he was known then) was the business manager. A freshman came to me, in tears, because he had filed an expense report for a trip to New Haven to cover a Princeton-Yale game. The kid had put in for some gasoline, oil, and a few dollars worth of tolls on the Garden State Parkway and Connecticut Pike.
Stossel had disallowed the tolls. “What’s going on?” I demanded of Stossel. “The kid could have taken local roads,” he responded.
C’mon, Stossel, give me a break — the phrase that Stossel would later make famous as a consumer reporter and use as the title of his bestseller published when he was co-host of ABC’s 20/20.
In 2004, when that book came out, I wrote a column about it and noted that “those lofty libertarian ideals of private enterprise stepping in where government has failed always sound great at first. But as everyone knows, government has to protect us in many critical areas. Even Stossel concedes that without some government protection the environment would be quickly ravaged.”
But I had to give him a break on his suggestion that the Food and Drug Administration could operate with voluntary compliance. He had a good explanation, I wrote: “For one thing private competitors would get into the business — he cites the example of the private Underwriters Laboratory, which now has some 17,000 appliances listed as UL-approved, a designation that manufacturers work hard to attain. For another thing, without the government attempting to do the approval work for us, we all would become much more vigilant. One adverse reaction to a medicine and the Internet will be buzzing with the report.”
In 2014 I quibbled with Stossel once again. He was appearing on a Princeton Reunions panel on conservative values, and I checked out one of his Fox television shows. On it he made the classic argument that big government was quashing private enterprise. “The poster child for his argument was, literally, a child,” I wrote. “An elementary schoolgirl who had baked some cupcakes for a classmate’s birthday discovered that other kids loved her creations. She started a home-based cupcake business and then — thanks to some big bad government bureaucrats — was forced out of business after she failed to meet the myriad regulations imposed on food businesses.”
In my column and in a later E-mail exchange I argued that — thanks to the Internet and advanced technologies such as desktop publishing and 3-D printers — many start-ups were easier than ever.
Stossel had a counter-argument: “Rich, what you miss is that while it’s easier to start an Internet biz today, that’s only because technology has advanced faster than the regulators (so far) can regulate. It’s new, so there are few rules. Also there is free speech protection.
“But try to start a chemical biz, or manufacturing factory, or sell food, or medicine, or transportation, etc., or employ more than 50 people even in an Internet biz. There are so many rules that many people don’t even try anymore. Of course you might argue that survivors love the regs because they keep potential competitors at bay.”
We can argue more on those points, but meanwhile I have heard again from Stossel, this time in the form of a column posted at www.foxnews.com. Give the TV guy credit for grabbing our attention:
I write this from the hospital. Seems I have lung cancer.
My doctors tell me my growth was caught early and I’ll be fine. Soon I will barely notice that a fifth of my lung is gone. I believe them. After all, I’m at New York-Presbyterian Hospital. U.S. News & World Report ranked it No. 1 in New York. I get excellent medical care here.
But as a consumer reporter, I have to say, the hospital’s customer service stinks. Doctors keep me waiting for hours, and no one bothers to call or email to say, “I’m running late.” Patients can’t communicate using modern technology.
I get X-rays, EKG tests, echocardiograms, blood tests. Are all needed? I doubt it. But no one discusses that with me or mentions the cost. Why would they? The patient rarely pays directly.
I fill out long medical history forms by hand and, in the next office, do it again. Same wording: name, address, insurance, etc. I shouldn’t be surprised that hospitals are lousy at customer service. The Detroit Medical Center once bragged that it was one of America’s first hospitals to track medication with barcodes. Good! But wait — ordinary supermarkets did that decades before.
Stossel won’t get many arguments on that score. Most of us adore our doctors but no one likes the repetitive forms, the inability of a physician to put his or her hands on a test that was administered a few years ago or a few miles away, and the overly complicated health insurance policies.
On all that I heartily agree with Stossel. But as for his prescription to cure the problem, I have to quibble once again.
Stossel writes that “customer service is sclerotic because hospitals are largely socialist bureaucracies. Instead of answering to consumers, which forces businesses to be nimble, hospitals report to government, lawyers, and insurance companies. When there’s a mistake, politicians impose new rules: the Health Insurance Portability and Accountability Act paperwork, patient rights regulations.”
Hold it there, Rick. I blame a lot of the paperwork problems on HIPAA rules. As a non-celebrity, at an age where anyone can figure out what physical problems I am likely to have, I would be happy to sign a waiver on privacy so that I could be fast-tracked through the medical admission process. But would he? Or would someone in their 20s or 30s who has an employment interview looming?
Insurance is another issue. Writes Stossel: “Markets work when buyer and seller deal directly with each other. That doesn’t happen in hospitals. You may ask, ‘How could it? Patients don’t know which treatments are needed or which seller is best. Medicine is too complex for consumers to negotiate.’ But cars, computers, and airplane flights are complex, too, and the market still incentivizes sellers to discount and compete on service. It happens in medicine, too, when you get plastic surgery or Lasik surgery. Those doctors give patients their personal E-mail addresses and cell phone numbers. They compete to please patients.
“What’s different about those specialties? The patient pays the bill.”
Sounds good on paper. But think back to the last time you came out of anesthesia. Were you in any shape to negotiate anything? Was your significant other?
I imagine being rear-ended at a traffic light, ending up in the ER, and arguing over the price of an EKG. “My cardiologist does them at his office for peanuts,” I argue. “Why should I pay so much more here?” The incentivized physician replies: “Maybe you should have spent a few dollars to take the toll road. Then you would have avoided the stop lights.”
To my college classmate John Stossel: Recover quickly, stay well, continue to be a contrarian and rational voice in the media, and — please — give me a break.