Are we headed towards a world in which each test, each procedure, and who knows, perhaps even each prescription, comes right out of the doctors pay or bonus?
If so, there is a BIG problem! The "logic" driving this is based on several utterly FALSE assumptions and the "less is more" approach actually increases costs and misery all around.
"Lower prices for medical care are the major explanation for the much lower medical costs of all the other rich democracies relative to the United States (37). Competing explanations—that the U.S. population is particularly unhealthy or that Americans use many more medical services—are largely false. In a detailed examination of health care spending patterns, the McKinsey Global Institute concluded that the United States population is "not significantly sicker" than that of Japan, Germany, France, Italy, Spain, or the United Kingdom (3)."
That quote was from From The Obama Administration's Options for Health Care Cost Control: Hope Versus Reality
The following also is..
" The McKinsey Global Institute also found that "U.S. patients consume approximately 20% less prescription drugs" in 9 therapeutic areas than do patients in Germany, Canada, or the United Kingdom (3). Furthermore, the average number of hospital days per year in the United States is the second lowest among 12 comparison countries, although American patients receive more inpatient surgeries and imaging services than patients in most peer countries (3). Other studies (38) similarly conclude that "the prices of care, not the amount of care delivered, are the primary difference between the United States and other countries" in health care spending." -from The Obama Administration's Options for Health Care Cost Control: Hope Versus Reality
What IS causing the rise in prices, then? Malpractice lawsuits? No, they, and the cost of paying them are at record LOWS.. Less than 0.6% of costs are directly or indirectly attributable to any malpractice related costs.
"All other rich democracies concentrate purchasing power to counter the medical industry's efforts to increase costs (34). If, as in Canada and Sweden, overall medical costs are on public budgets, then officials have powerful incentives to restrain increases in medical costs to avoid reducing the funds for other public programs or having to raise taxes (36). In other countries, such as Germany and France, insurers are nongovernmental entities (sickness funds) that are financed through payroll contributions from employers and employees. The governments of these countries regulate insurers and help them control costs (34). Germany, for example, regulates the level of social insurance contributions (taxes) paid by employers and workers, thereby limiting the budget for all sickness funds."
The "less is more" philosophy led to a method of paying doctors called "capitation". In theory it sounds okay, but the reality is that patients with complex problems never get them addressed, and often, doctors end up hating their profession and their patients.
Eventually, Capitation was discredited and discarded in many places, but now it has re-emerged under a new moniker, "pay for performance". Basically, its medical segregation, because the result is often dangerously abbreviated medicine in which doctors guess what might be happening, and don't verify, with a predictable, growing number of medical mistakes. California, the heartland of the capitation movement, didn't push to end the mistakes, instead it capped medical damage awards, making it impossible for injured patients to get legel help, even in the most appalling cases, a carelessly damaged or ended human life just wasn't worth a lawyers time.
So why are some within the Obama administration quietly encouraging it again, why are they ignoring the imperative to improve quality, instead of DANGEROUSLY pushing DOCTORS to make guesses instead of verify with tests, but still take the money as if they were delivering care from sick PATIENTS, (creating MORE INJURED PATIENTS) trying to take health, the only thing many people have, and what amount to pennies out of poor people's pockets, costing far more in the long run.. and avoiding the REAL ISSUES?
If US patients have ALREADY been forced to use FAR less services by high costs, is further cutting them a good idea? Won't that increase the costs, in the long run, not lower it?
Good point. Well, MAYBE, GIVEN THAT HEALTHCARE, TO SOME, IS THE "ONE BRIGHT SPOT" in a DISMAL economy, MAYBE THAT IS THE REAL INTENT?
I hope not! But, it would make sense, given the obscene level of corruption in the US's uber-kleptocracy.
But I'm getting off track.. Why not REAL cost control, not guaranteed to backfire "cost reduction" schemes that ACTUALLY INCREASE COSTS..
Also from The Obama Administration's Options for Health Care Cost Control: Hope Versus Reality
"The starting point for understanding the politics of cost control is an axiom of medical economics: A dollar spent on medical care is a dollar of income for someone. In other words, national health expenditures constitute the money that the medical care industry—from physicians, nurses, and hospitals to pharmaceutical companies, insurers, lawyers, and sales and marketing staff—earns. Controlling costs necessarily requires restraining the industry's income (8, 9). As a consequence, serious attempts at cost control produce a battle with stakeholders who have resources, political clout, and strong incentives to oppose measures that reduce the rate of medical spending growth and their income."
Makes sense.. Didn't Max Baucus say something about how a insurance-exec/former Baucus staffer/lobbyist, Liz something or other, actually had "written the bill"?
"The Obama team's approach to health reform does not, however, fully embrace the central lesson of international cost-control experience. Effective cost control requires strong government leadership to set targets or caps for spending in the various sectors of medical care (hospital, pharmaceutical, and physicians), either directly or through insurers. The targets may not always be binding, and these caps would be on total expenditures, not services. But without explicit targets and continual efforts to enforce them, no health care system can control costs. That lesson is evident in countries ranging from Canada, Sweden, and the United Kingdom to France, Germany, and Japan (34). In Germany, for example, caps adopted in 1986 had a dramatic effect on spending for physician services.
Some analysts stress other, less reliable lessons about how other countries have controlled costs (41). These arguments often confuse association with cause. For example, other nations do indeed use electronic health records (EHRs) more widely than the United States, but use of EHRs is not why they spend less on medical care. These countries had much better cost control than the United States long before the spread of EHRs (34). No studies have identified different levels of use of health information technology as a primary explanation for why U.S. health care costs exceed those of other nations.
Similarly, the United Kingdom has a National Institute for Health and Clinical Excellence (NICE), and health care costs in the United Kingdom are much lower than in the United States. But these facts are not causally related. The NICE makes recommendations about covering new medical technologies and interventions on the basis of cost-effectiveness principles (and is often cited as a model by American advocates of comparative effectiveness research) (42). However, NICE's main aim has been to rationalize decision making about coverage decisions rather than to constrain spending; it has not operated as an instrument of cost control. Indeed, since NICE's establishment in 1999, spending in the National Health Service has dramatically increased (from 7.2% of gross domestic product in 2000 to 8.4% in 2006) as the British government sought to meet the European Union norm and satisfy long-standing demands for improved, more accessible medical services (43).
In short, if medical costs are to be controlled, no substitute exists for constraining prices and capping expenditures. Frank talk about these cost-control realities, however, is politically difficult. It immediately elicits alarms from the medical care and insurance industries about "rationing" (ignoring the fact that the United States could realize significant savings from lower prices and administrative costs). Others, particularly the pharmaceutical industry, raise alarms about the effect that cost control would have on the pace of medical innovation. In addition, spending targets constrain medical providers' income and thereby prompt intense political struggles. The Obama team's limited treatment of cost-control realities—including the absence of global budgets and spending targets or caps—seems to reflect a desire to avoid such political controversies."
So, where does that leave us.. Is Hope, gone, already? Why wait FOUR YEARS to learn that when we know it now?
"...a decision is being made by the President and the Joint Chiefs in the Healthcare Room at the Pentagon. And when they realize there is no possibility of recalling the Hope, there will be only one course of action open. Total commitment.
Mandrake, do you recall what Clemenceau once said about healthcare?...He said healthcare was too important to be left to the generals. When he said that, fifty years ago, he might have been right. But today, healthcare is too important to be left to politicians. They have neither the time, the training, nor the inclination for strategic thought..."