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Monday, July 07, 2008

How will a government single payer work?Go to the Happy Hospitalist to see how it did/does work for Medicare

Everyone who is a physician or is training to be one,everyone who is a patient or who might someday be one (that really is almost everyone) needs to go now and read and re-read one of the latest essays by the Happy Hospitalist. Physicians to whom the education of physicians is entrusted should either copy that post and hand it out or send all of their students to the the link on the web .Would anyone like to wager that it will not find its way into any publication from a major medical organization?

Physicians who are so fed up with what medical practice has become and are so desperate that they are now recommending a single payer should read his article and see if their views about a single payer will change.

Happy explains what the CMS system is. If he is right,and I believe him to be right, the ship will sink in a few years and there will be not enough primary care docs to care for those folks who will need their services. Of course, many have prophesied that as well but the professional organizations such as ACP who also forecast disaster have not offered a viable solution, in my opinion.

The die was cast in 1989 with the passage of the Omnibus Budget Reconciliation Act. Wage controls were enacted for Medicare services, something that was promised to not ever happen when the Medicare bill was passed. With price controls one can expect shortages, increased demand , poor service and even black markets. All of the expected consequences did not occur overnight, but most (I don't think there is much of a black market yet) are very evident now and are getting worse.

The system that HH expertly explains so far has damaged the primary care physicians most but one can see effects moving up the doctor food chain. We are seeing ob-gyns offering botox and selling vitamins and are told there it is easier to get a vascular surgery fellowship than a dermatology residency. We read that a nurse anesthetist (CRNA) is averaging higher incomes than an internist or family doc or peds doc. Orthopedists are using PAs to do some of the non-procedural stuff (e.g. actually talking to patients) so their time can be spent with the higher paying activities like sawing and sewing.When you read how the system works much makes more sense: why we suddenly can't get by without hospitalists while 20 years ago there were no such entities, why the old medical ethics of putting the patient first had to be replaced by social justice concerns and a utilitarian viewpoint.It is the covert rationing so cogently explained by DrRich.

We all should know what wage and price controls do but the CMS system is worse than that. It is structured so that it will self destruct. Go to HH's post to see how that works.It is a death spiral of ever increasing volume and decreasing payment per unit of service that is crushing primary care and those docs who do the procedures will survive only a little longer.

He references his proposed solution in his blog. I don't know if his cure is the right medicine or not but he sure has done everyone a great service by explicating the pathophysiology of the problem.

1 comment:

The Happy Hospitalist said...

James. You are so kind.