Tuesday, May 06, 2014

Has the third party medical payers' dream come true,physicians as medical resource stewards practicing parsimonious care working for the common good

No longer do the third party payers (TPP) have to deal with the physicians and patients working against their bottom line. Physicians,  patients and the TPP will work together in harmony in the land of rainbows,unicorns and the big rock candy mountain.All the stakeholders can get together and work on ways to eliminate waste,low value care and conserve the third party payer's society's scarce resources.Actually TPP have not been dealing with physicians for some time now, they interact with providers of health care.

 The following dream of the TPPs might just be coming true:

Careful analysis of aggregate data  in which patients will gladly participate   will allow cost effective guidelines to be written and executed as all players will realize the wisdom in maximizing the health and well being of the population.The utilitarian ethic of the greatest good for the group will be recognized as the only sensible alternative to the selfish pursuit of individual gain which previously motivated both the selfish patient,concerned as she was with her own health and the health of her family  and the avaricious physician,driven as he was by the flawed and destructive fee for service  system. Value not quantity will be served .

Third party payers should be eternally grateful to the progressive thinking leadership of such organizations as the American Board of Internal Medicine and its foundation,the ABIMF (which was generously funded by the thousands of socially minded internists who sat for repeated examinations) and the thought leaders at The American College of Physicians (ACP) who managed to convince many that providing less care is better for everyone not the least of which are the third party payers and the medical progressive elite who alone will have the wisdom and expertise to determine what is best for everyone.

Can the Choosing Wisely campaign be explained by 1)the follow the money principle and 2)the Baptist and Bootlegger story.

Of course , the dream perhaps had not been completely realized yet. There are still obstacles to overcome;

1) the self interest of the patient and the patient's family. Most people do not think when they develop chest pain " I'm going to the Emergency Room to see how the Doctor can balance my immediate needs with those of society. In other words, one aspect of that darned incentive problem.It is hard to stamp out that pesky tendency of folks to try and act in their own interests and in the interest of those they care deeply about.

2 )that pesky Mal-practice issue . So far the argument that Mr..Jones did badly but it was OK because we followed the latest cost effectiveness guideline has not risen to the level of a major legal defense

3) Reminiscent of the WWII. Japanese soldiers who held out for years on isolated islands not aware they had lost, there are still some physicians who,perhaps educated in an earlier era with a different and less enlightened  ethical upbringing , still believe and as if they are the fiduciaries of their patient.Perhaps time will take care of those dead-enders  but until then the TPP utopia will not be completely  realized in spite of the well funded campaign to convince physicians of their duty to conserve medical resources by following guidelines.







1 comment:

Troglodytum Brachiandum said...

Perhaps you missed the most important part. "Medical Ethics," in the bourgeois sense, is ONE PERSON applying reason to a situation concerning the care of ANOTHER PERSON.
Both of these are redolent with individualism. Rather, perhaps the SOCIETY should make rules for what a prior SOCIAL REASONING will be applied to a citizen in every case. Therefore, workers can participate without the onus of "ethical decisionmaking," but simply following orders.
This is tommyrot, and has killed millions in the process of proving empirically that it is nonsense. Evidence-based sociology says you can walk for miles on the bodies of the dead without touching the ground - ask Mao.
But yet, we will try and try again. We don't have enough of a "population-based healthcare" mind to avoid using techniques that result in genocide. That's not our department.