Wednesday, September 29, 2010
"The health care wedge is one way of thinking about government involvement in the economy. When the government or a third party spends money on health care, the patient is not. The patient is then separated from the transaction in the sense that the costs are no longer his concern. This separation--how far the supplier and consumers are separated from one an another--is what the economic wedge is measuring."**
On the consumer side of the market, the wedge diminishes consumers' incentives to monitor costs...On the supplier side, doctors and other medical providers receive no incentive to provide higher quality services for less cost.
There is well documented evidence that individuals respond to lower cost-sharing by using more care, as well as more expensive care, when they do not face the full price of their decisions at the point of utilization.
"Accelerated medical inflation, consequently, is strongly correlated with a growing separation (wedge) in the medical market between doctors and patients."
In the case of health care, the wedge also separates patients from doctors in determining what type of care should be provided. Decisions are made by government, insurers, and judges deciding medical malpractice liabilities.The government, lawyer, and third-party wedge in our current health care system causes [both] higher costs and diminished efficiency.
Saturday, September 25, 2010
• 74% [of hospital CEOs] plan to employ a greater percentage of physicians over the next 12 to 36 months.
• More than 70% say they have received increases in requests [from] physician groups for employment.
I spoke to John McDaniel, founder and CEO of Peak Performance Physicians, a practice management firm in New Orleans, and he pointed out to me that what’s driving hospital physician employment is not only anticipation of lower reimbursements under reform but the mounting costs and complexities of doing business.Complexity per se is not the problem doctors are currently facing. Medicine and business are replete with complex problems which must be faced and dealt with on a daily basis. The problem is that far too much of the complexities doctors must deal with are the constantly shifting mandates and regulations which substitute the plans and values of the politically powerful for the plans and values of patients working privately in conjunction with their doctors.
Friday, September 24, 2010
In recent political debates, the autonomous physician has been portrayed as a problem to be solved, an out-of-control actor motivated by greed---and a major cause of rising health-care costs...
Physician autonomy is a major defense against those who comfortably sit in remote offices and make calculations based ont concerns other than an individual patient's welfare. Uniformity of practice is a nonsensical goal that fails to allow for differing expression of disease states.
this is not to say that critical research, randomized controlled trials, literature meta-analysis an guidelines are not necessary and useful. They are all essential...But we must recognize that many physicians will often make decisions that deliberately do not conform to "community standards"---and that patients will be better for it.
Dr. Greenfield correctly points out that quality medical care consists of physicians applying their independent assessments to the unique circumstances of each individual patient. Without autonomy, this goal can not be achieved.
Tuesday, September 21, 2010
“Today, this isolated relationship is no longer tenable or possible… Traditional medical ethics, based on the doctor-patient dyad must be reformulated to fit the new mold of the delivery of health care...Regulation must evolve. Regulating for improved medical care involves designing appropriate rules with authority...Health care is being rationalized through critical pathways and guidelines. The primary function of regulation in health care, especially as it affects the quality of medical care, is to constrain decentralized, individualized decision making.” (emphasis added)from New Rules, by Donald Berwick
"To realize the full benefits of the Affordable Care Act, physicians will need to embrace rather than resist change. The economic forces put into motion by the Act are likely to lead to vertical organization of providers and accelerate physician employment by hospitals and aggregation into larger physician groups...The health care system will evolve into 1 of 2 forms: organized around hospitals or organized around physician groups...Only hospitals or health plans can afford to make the necessary investments in technology and management skills."
"I can not believe that the individual health care consumer can enforce through choice the proper configurations of a system as massive and complex as health care. That is for the leaders to do."
"I would place commitment to excellence--standardization to the best-known method--above clinician autonomy as a rule for care."
Saturday, September 4, 2010
“Socialized insurance necessarily leads to socialized medicine, and if the government controls well over half of the insurance sector through Medicare and Medicaid, and tightly regulates the rest, it is only inevitable that it will also seek to control how health care is bought and sold.”
— David Dranove on ObamaCare, at The Health Care Blog
The more the government controls health care delivery, the more it will have to control medical decisions themselves, which means less control for is left to individual doctors and patients.
Proponents of the ACA continue to claim that it is NOT "socialized medicine." The desire to distance the law from this term is because it is well known that socialized medicine does notimprove quality and access and does reduce individual freedom. Tthe essence of socialized medicine is centralized government control for the purpose of creating material equality by taking from some to provide for others--and that is exactly what the new law is designed to do.
Let's call it "socialized medicine"---because that's exactly what it is.