I have been suspicious of most of the medical organizations pushing health reform of the Obama type. I have previously proposed that the problem with cost that we have is due to the effort to achieve pre-paid care, and ultimately free care. The medical organizations that have been pushing this type reform usually have an ulterior motive. The AMA gave up its credibility in 1986 with RBRVS. That was sold to the primary care organizations as a way to take money from specialists, especially surgeons, and give it to the primary care docs. I remember being told at the time that they were doing it for that reason. Well, it didn’t work. Everybody got screwed in a typical “prisoners’ dilemma” situation.
Now, here we go again and the usual suspects are pushing the same argument.
The Congressional reform proposals are based on a widespread consensus that the current model of fee-for-service payments undercompensate evaluation and management services as compared with procedures and technical services, do a poor job of providing incentives to clinicians for collaboration, do not improve efficiency, are not focused on quality and outcomes, and do little to encourage wellness and prevention.
It is well known by everyone in health care that “wellness and prevention” do not contribute to reduced costs except as general public health trends. If obesity is responsible for increasing levels of type II diabetes, for example, doctors are going to have little effect on that trend, no matter how they might scold patients. However, pushing “wellness and prevention” is a way of trying for a bigger piece of the reimbursement pie.
In fact, every step in the march toward government medicine has resulted in less, not more, money for primary care. That is why primary care physicians are leaving the Medicare program and selling their services, in a variation of the fee-for-service model, to patients for cash. The command economy types will never understand that because they do not understand private business. In their world, everybody works for the government, or academia which is the same thing.
Tags: economics, health care