Sunday, July 19, 2009

Should the symbol of Massachusetts Health Plan be the canary or the dead parrot?

An argument can be made for either candidate.

The canary,as in the canary in the coal mine, served as a early warning system for respirable hazards in the mines, and the experiment in Massachusetts in mandated health insurance can serve to demonstrate what might happen if the Mass. plan goes national as may occur with plans now being written in Congress. So far we have seen costs significantly higher than the plan's advocates claimed,significantly decreased access to care and most recently efforts underway to control costs cost by radically overhauling payment systems for medical care. The latest is a capitation plan which would turn the (at least) public portion of Mass-care into a big HMO with features that make regular managed care look like your overly generous uncle.

Economist Arnold Kling comments on the events in Massachusetts and the first comment in reply to his entry explains why capitation did not work when tried in the 1990s. Sandy Swarc at Junkfood Science has this detailed review of how badly capitation worked out and the implications and effects that a capitation system has on medical ethics.I have written before about the destructive effects of a HMO-capitation system on the physician-patient relationship and the attempts to redo medical ethical principles to be "better suited" for the statistical morality of group outcome data and payments directives based on them in which the physician is directed to care for the group's outcome and not be mired in the outdated belief in the primacy of the fiduciary duty to the individual patient.

The dead parrot also might be considered a mascot or symbol because of analogy to a classic Monty Python routine seen here. In this sketch the customer is complaining that the parrot he recently purchased is dead while the store clerk steadfastly maintains that the bird is sleeping or resting. The opponents of the Mass-care point to the rising costs and decreasing access to care as a failure while the advocates deny the bird is dead and scramble to devise more fixes to salvage a spiraling failure with more government controls and less patient choice and opportunity for physicians to use their judgment and care for their patients.

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