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Thursday, April 28, 2016

The authoritarian coercive aspect of the progressive medical elite

George Will has commented on the recent authoritarian  activity of of attorneys general and  the justice department to go after climate change "deniers", (a derogatory term to suggest a similarity to round earth deniers and Holocaust deniers.)

Will talks about the authoritarian facet of progressives. I submit the subset of progressives in the medical elite has the same frightening characteristic.

Here are some  examples;

1) Dr Robert Benson ,former CEO of the ABIMF,writing on the blog of the ABIMF is explicit about what he desires in regard to the Choosing Wisely initiative of the ABIMF. ( It should not go unnoticed that the funding for this program , the motive of which I have ranted about before, comes largely for fees charge to internists for their certification and recertification  exams and for other time consuming  programs that have been made  part of their MOC ( Maintenance of certification program).

Benson wants the Choosing Wisely guidelines rules  to be determinate of Medicaid payments and memorizing of the Choosing Wisely  suggestions orders to be a requirement for being eligible to that the Certification exam for internal Medicine.See here for more details and my earlier comments on that.

quoting Dr. Benson : boldings added

" CMS, which has the ultimate negotiating position in the form of reimbursement for Medicare services, could only accept negotiated bundled charges. It could also refuse payment for non-compliance with the Choosing Wisely recommendations."...ABIM could require candidates to achieve a perfect score on questions related to costs and redundant care as a requirement for admission to secure exams for initial certification or MOC."

2) Like minded thoughts are expressed in the NEJM by Dr. Nancy Morden of the Dartmouth Institute for Health Policy and Clinical Practice:

"..linking the lists ( of tests and procedures not to do ) to specialty specific maintenance of certification  activities such as practice audits and improvement tasks could also advance their dissemination and uptake at very low cost."

"...Choosing Wisely items should also be incorporated into quality-measurement efforts such as Center for Medicare and Medicaid Services Physician Quality Reporting  ...linking low value service use to financial incentives ( translate penalties )  .. should accelerate ...into practice changes."

3) Drs Don Berwick and Troyen Brennan in their book "New Rules" are not subtle in the following quote:

"Today, this isolated relationship[  speaking of the physician patient relationship] is no longer tenable or possible… Traditional medical ethics, based on the doctor-patient dyad must be reformulated to fit the new mold of the delivery of health care...Regulation must evolve. Regulating for improved medical care involves designing appropriate rules with authority...Health care is being rationalized through critical pathways and guidelines. The primary function of regulation in health care, especially as it affects the quality of medical care, is to constrain decentralized individualized decision making.

When one talks about constraining and reformulation and "rules with authority" , the coercive aspect is obvious. Of course the progressive medical elite is authoritarian, they are progressives. 

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