What happens when the people lose trust in you? You get kicked out – It might take a while, but it will invariably happen. And what's amazing is that those in whom the public has lost trust are always surprised by the news and its effect. Despite the polls, despite the simmering anger, despite the clear signs of frustration, it always comes as a surprise. For over a decade, average family income in the US has gone down in real terms, or stayed flat. The relationship between stagnating incomes and ever-rising health care costs has been strongest in the so-called Blue states, many of which saw a change of leadership this week. Unemployment rates might have gone down these past couple of years, but if I can't pay my bills I'm not a happy camper, and after listening to the same old same old, it's difficult to maintain any level of trust. In a NEJM Perspective published last week, Bob Blendon and colleagues report on the vanishing trust of physicians held by the people in the US. This, like many of the more recent shifts in the industry can find its root cause in the cognitive disconnect between those who feel that the average person only needs listen to them and trust them, even though that average person's life is further impoverished every day. The American people are angry about the costs of health care and frustrated by the inability to get a straight answer to a straight question: How much will this cost and do I really need it?
What this means to you – While the physicians of this country don't have to worry about getting voted out, the political leaders in the States in which those that are most tone deaf practice should be….and are. Take NY State for example. It has one of the highest premium rates in the country, and by now we all know that high premium rates are simply the result of high prices. The State's leaders recently commissioned a study to release comparative pricing information on hospitals, trying to shed light on contracts between insurers and providers. Of course, to an extent, this step is surprising given that in early 2011 – yes, close to 4 years ago – the NY Legislature adopted a law to enable an all-payer database. So why, one could ask, don't the leaders of NY simply use the information contained in the database to answer questions about hospital prices? The answer is simple: the agents of the status quo, the tone deaf, have consistently blocked any attempt to create a useful database. And now, faced with an executive action, they're whining again. The usual farm animal manure-smelling arguments are being put forth, and, this time, we hope to no avail, because one thing is certain after this week….ignore Americans' frustration at your own peril. And when the polls consistently show that the people don't trust you, you should be very worried. If you're not, well, better start brushing up that old resume because you'll need it soon enough.