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Why Not?
Described by the NYT as “a veteran health care expert who oversaw the federal Medicare and Medicaid programs for the first President George Bush and advised Senator John McCain in his presidential campaign last year,” Gail Wilensky tells the paper:
… the entire health care system should stop paying doctors an individual fee for each service they provide patients — something experts say encourages over-treatment and waste — and alternatively, for instance, persuade them to join together with different specialists to offer an array of services for one lump sum.
The NYT adds:
This idea is widely supported by conservatives and liberals alike, but no proposal to set up this new payment system has gained attention.
Why not? In what kind of twisted world do we live, where a “widely supported” idea does not “gain attention” or traction? More importantly, why do voters tolerate such negligence? The answer — as the larger NYT article suggests, based on the reaction of certain disappointed conservatives themselves — might very well be this: Because we’re too pre-occupied arguing about baseless sound bites.
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7 Responses to “Why Not?”
For all the teeth gnashing about the supposed power of the insurance industry, people want to look at the AMA and it's influence. The reality is that changing the way doctors get paid will likely result in doctors receiving less pay – they are not going to stand by and allow that to happen.
Capitation is no surprise. This has been an issue since at least the 1980s, and resurfaced during the Clinton health care effort. This also openly resurfaced earlier this year, when Obama discussed some “innovations” that include capitation (he evasively avoided using the term, and talked down to his exploitable Herd by saying something like “single payment” and “moving away from fee-based system”), something examined already in Massachuetts.
http://www.mass.gov/Eeohhs2/docs/dhcfp/pc/Final…
And of course, comes something different, but which is related, an overall “cap” or “ceiling” (limit) on total expenditures (which forces rationing and other unpleasant things that knowledgeable people have expressed concern about, while the Herd denies it and disparages those who know and report the truth).
The Clinton plan, after all (though some will still deny what its architects have said themselves) was “Managed Care Under a Cap.”
[PDF version of Starr book I own in hardcopy form]
http://www.princeton.edu/~starr/HealthReform/Lo…
For those of you who want faster reading, look here.
Starr: Managed competition, under a cap
http://www.prospect.org/cs/articles?article=hea…
Why hasn't this become an important element of any of the reform plans? Because the CBO says it won't save very much money: only $5 billion over 10 years (see option 37 here – http://cbo.gov/ftpdocs/99xx/doc9925/12-18-Healt…).
Why doesn't the government force a lot of physicians currently functioning as private small businesses to merge into large corporations? Gee I can't think of any reason not to do that.
Obama payed lip service to the idea when he praised Mayo (to which Mayo replied, 'Um, but your proposal doesn't adopt the cost saving measures we use.')
What immediately came to mind when I read about Mayo's approach is that it works well for them because a) economy of scale, which you wouldn't be able to reproduce in smaller communities and b) their reputation and constant strive for excellence- they may be paying their doctors on salary but I'm sure those salaries are substantial.
As usual, ideas can be good ideas but we shouldn't jump to the conclusion that they will function the same way in all situations.
twoods01602 provides a link…that has nothing to do with the current debate. It is looking only at budget options for Medicare. In addition it should always be remembered that the CBO admits that it has problems with estimating health care costs because of a lack of experience.