I know the good doctor Jay Parkinson has addressed this before, but I think it’s worth taking another look.Thanks…it’s actually very simple. It doesn’t matter who pays for healthcare if doctors are incentivized to do as much as they can and the processes of delivering healthcare are such a convoluted mess with no deliverer nor payor of healthcare responsible for your health. The government could try to streamline the process of reimbursement so doctors can get paid, but then they could also one day decide to pay half as much as they currently do to physicians. This essentially makes physicians government workers and that’s too risky to devotees to social status. I didn’t pay $250K and spend 9 years of my life working my 20’s away to become a postal worker. This simply won’t fly in America. Doctors won’t go for it and there would be a massive exodus amongst physicians out of the single-payer plan and into that cash-based second-tier. We’re already seeing that. Doctors are dropping Medicare. Why? Although Medicare always pays on time (it’s a nice little streamlined process for getting paid), they pay very little. So many physicians think that getting paid on time doesn’t outweigh the sacrifice of getting paid very little.
All of these top-down reformations don’t really matter. Even the CBO says that costs will continue to rise at 8% every year with Obama’s proposed reformations.
Specialists know they can’t continue making as much money as they do. They will have to cave to something that’s not as good as they have it now, but nowhere near being a government worker. Insurance companies know that they can’t expect the average American to pay 40% of your pre-tax income toward healthcare (which will happen in 8 years even with Obama’s proposed reformations). Hospital systems know they can’t control local doctors who independently contract with them. If they try, physicians threaten to leave them for the competition. And Big Pharma knows that they can no longer make money on blockbuster drugs with their current business model (huge investments with very little chance of return). When I speak to these groups, they know exactly what I’m saying when I say they are living in a fantasy world if they believe this can and will continue.
I now say the pressure is on. The first company who can create small scale healthcare “systems” rooted in today’s technology and careful process design along the lines of mini virtual Mayo Clinics that can deliver healthcare at half the cost with marked efficiencies will win…and they’ll win big. Healthcare will be reformed through disruptions just like many of the businesses from the 20th Century have been disrupted by smaller, much more effficient companies without the baggage of the 20th Century. It’s either disruption or literally force doctors to become government workers. And last I checked, it’s a free country bound by the pursuit of life, liberty, and happiness.
In the recently published “”American Values” — A Smoke Screen in the Debate on Health Care Reform”, Dr. Alan Brett makes the claim that the single-payer system is being rejected by leadership due to political reasons; people feel that single-payer system is uniquely un-American, interest groups are vying hard to keep their business. Thus, leadership is opting instead for a “public-private hybrid.” http://content.nejm.org/cgi/content/full/361/5/440
Everything has to come down to the economics of the system. Jay points out that it’s not about who’s paying the doctors. Rather, it’s about whether the institution is paying is stable, fair, just, etc? It seems to me neither the government as an overarching institution nor the insurance companies (at the status quo) are able to make those judgements. On one hand, we have public bureacracy, a mess of its own, and on the other hand we have extreme private interests, which are extremely slowly (and also bureacratically) making tiny steps to reform; although, it seems that those lines often blur. Each option has its benefits and drawbacks. Health care is extremely advanced in the US, but often, having advanced technology doesn’t mean efficient health care. But in the current system, physicians are financially incentivized to use technological solutions first to get paid by insurance companies as well as to protect themselves from malpractice.
I want to study Cuba’s health system more, a centralized health care system that is purportedly amazing.
Random health care thoughts. Back to finishing up an article for the hospital newsletter :)
