Monday, August 3, 2009

ObamaCare 191

I wanted to expand a little bit on my comments about health care, and specifically, I want to look at Obama's quote in which he said that doctor will be paid for quality of care, not quantity of care.

On the surface, that almost sounds like a good idea. I want my doctor to be more concerned about delivering me the best quality care I can get, and not be concerned about running 100 patients through in a day. Wouldn't you agree that would be a good thing?

The problem is in the government trying to institute a system in which everyone gets the best care possible.

I think we have to look at that statement as two separate, and unrelated parts. First, doctors should get paid for the quality of care. As I said in my previous post, what this means is more government reporting. Your care may not get better. It may not change at all. It may even get worse. But your doctor is going to be required to report more to the government to insure that you meet certain "minimum" standards for care.

The "mimimum" standard is the key.

Just as in education in which quality has been consistently brought down to "minimum acceptable standards," the same will happen in health care. The government will determine what "minimum" tests you need to make a diagnosis or to treat a disease. They will pay for these tests. They will not pay for any additional testing your doctor might want to do that is outside of that "minimum standard" range. Ultimately, this is designed to be a "cost saving" aspect of the program, not a "quality improving" aspect of the program.

How about the "quantity of care" comment. You might think the two are linked, but they really are not. Currently doctors get paid from medicare on a "fee for service" basis. In some private insurance programs, HMO's and certain other situations, doctors get paid a flat fee or a salary instead of "fee for service." In those cases, often the doctor contracts with the insurer for that kind of reimbursement, or he works as an employee for the HMO or a medical group.

When Obama says he doesn't want to pay based on "quantity of care," that means he wants to eliminate a "fee for service" type of reimbursement system. Now, that doesn't seem to be the situation under the proposals going through congress right now. That seems to be a "down the road" kind of issue.

Eliminating "fee for service" (in other words, eliminating paying based on "quantity of care") means one of two things: The doctor will be paid a flat fee for a specified number of patients; or the doctor will become an employee of the health care system, ie, the government.

Eventually, under the democrats, all health care workers would be government employees.

Until then, Obama wants to see a system that would "capitate" reimbursements. What that means is doctors would no longer have an incentive to see as many patients as they do now.

Put another way: rationing.


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This blog is about my opinions and world view.  I am a conservative, evangelical Christian.  Generally speaking, if you post a comment, I'll allow you to express your view.  However, if you say something hateful, untruthful, or just generally something I don't like, I may remove it.

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