Curiosity Over Pride
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Sunday, November 22, 2009
A Rose by Any Other Name...
I am not sure how much you have followed the latest solution du jour to fix our health care woes- reforming physician compensation models.
My punch line- "there are lots of way to compensate physicians and they are all bad".
So what stuns me most about the level of dialogue in this debate is the notion that the people who work in the trenches are really that stupid. Economists are an odd lot.
I think all of you know my position on rationing so I needn't discuss it again, but I want to take you for a walk for a moment down memory lane...
In the 1990's, HMOs, trying to keep costs down, actually paid some physicians more to do less testing, etc... this saved the HMOs, and therefore their members, lots of money.
Sadly a few instances arose- I am not sure how frequent these were and in truth I suspect they were rare- where it was found that the financial incentive to not perform testing negatively influenced patient care. Again, I suspect this was probably rare (though I don't know for sure) but the instances made headlines and juries reacted with massive economic damage judgements against the providers. In short order these compensation models vanished (at least as far as I know).
I want to highlight a small passage for your consideration: "The Finance Bill proposed automatic reimbursement reductions for doctors who order up the most care for Medicare recipients with similar medical and demographic characteristics. That was meant to respond to the research showing big disparities in spending on medical services for similarly-situated patients in different communities. But, Democratic sources say, that proposal ran into charges that it would promote rationing-and even function as "a death panel by proxy"-by compelling doctors to arbitrarily reduce care. So the final bill takes a less direct route toward a similar end. It requires Medicare to begin studying the utilization patterns of doctors participating in the program. And then it establishes a "values based payment modifier" that would, in a budget-neutral manner, increase reimbursements for physicians found to deliver high-quality care at lower cost, and reduce them for physicians at the other end of that spectrum. "It will, we believe, have the same net effect [as the original proposal]," said the Democratic aide. "It should change behavior around that threshold."
Does a rose by any other name smell as sweet?
As I have said many times before and will probably say again, the most expensive thing of all is the loss of trust. What does this do for your trust when eventually learn about it and realize that physicians are now paid by the government to do less testing when they see you?
Forgetting the obvious truth that HMOs are out to kill you but the federal government is here for your protection (as long as your protection is not less important than some other person/agenda that faction of the government is also trying to protect), do they really think physicians/attorneys/nurses, etc... are really that stupid?
Again, I am not necessarily opposed to this- though if I were czar I would do it differently- as I do understand the predicament we are in (at least I think I do).
But my point is that it was always trust in the system that was always the most important issue in the first place. Do you think most Americans understand this issue? When they do, will it help them feel more secure? If you are a conservative suspicious of government involvement to begin with, what will you think?
What has happened to this collective? We will send our children off to die to protect us (may or may not be a good idea) but we cannot accept small levels of personal insecurity so that we all personally benefit?