In a recent blog post, New York Times columnist and economist Paul Krugman dislikes the practice of referring to patients as “consumers,” arguing that medicine is such a noble profession that the regular rules of exchange of the free market, where customers pay for the services they choose to receive, shouldn’t apply.

Krugman notes that health-care providers are expected to behave according to higher standards than the average professional because they have to make life and death decisions, sometimes under severe stress. Doctors aren’t just “people selling services to consumers of health care,” he writes, because the service they’re selling is health — sometimes life.

That’s fine but doctors still expect to be paid and rightly so. The service they’re providing may be far more important than those provided by managers and economists but there’s no such thing as free care.

Health care professions aren’t like other professionals but Krugman never explains why patients shouldn’t be seen as consumers. He focuses entirely on the providers on care — which is refreshing given that the rights of medical professionals were largely forgotten in last year’s health-care debate — but he hardly mentions those receiving care.

In essence, patients are consumers. They pay their doctors for medical advice and treatment. The only reason to pretend that they aren’t is to legitimize a system of care in which patients don’t have to pay, or not pay in full, the care they receive. That is, the sort of public health system Paul Krugman supports.