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Tuesday, July 05, 2016

The 4th of July, Pride and "How Can I help you/"

This blog is for the most part about medicine and the practice of medicine so quoting extensively from a economist's blog might seem off track and one may wonder what if any is the link to medicine. This recent posting by George Mason University's professor, Don Boudreaux is so congruent with my core beliefs and he expresses them so well  that I have to quote him.

Broudreaux's topic is why, on the 240 th anniversary of the United States, we should be proud to be an American. See here for the entire essay.

Quoting from his blog, Cafe Hayek:

"...I’m proud of the peaceful manner in which most Americans conduct their private affairs.  I’m proud of the widespread respect for private property that continues to govern people’s personal, private relations.  I’m proud of the entrepreneurial spirit that continues to exist among many of my fellow denizens of these United States.  I’m proud of – and deeply grateful for – the innovativeness and entrepreneurial creativity of many of my fellow Americans.  I’m proud that America continues to be a destination for people seeking better, freer lives.  I’m proud that many Americans continue to believe that the most ethical course in life is for each individual to be self-responsible, self-supporting, hard-working, honest, and upright.

I’m proud, in short, of America’s bourgeoisness.  It’s this bourgeoisness that has made America great.  This greatness comes not from bellowing politicians, not from well-weaponed armies, not from arrogant judges, not from meddling bureaucrats, not from pompous Washington and New York and San Francisco pundits; it comes not from anything but the hundreds of millions of ordinary Americans who daily work hard, honor their contracts and other people’s property, cherish their families, friends, and neighbors, and think it perfectly natural to ask strangers in commercial settings “How can I help you?” "

 It has always seemed natural for a physician to ask that same question upon seeing a patient. In fact I recently saw an orthopedics for pain in my calf who asked that exact question.

As I read commentaries about the MACRA proposal and the nearly 1000 pages it takes to describe the process I wonder how long as the bureaucratic interference levels continues to increase and impede medical practice  will it be before that question will be merely perfunctory as more and more time and effort will be drained  away in an effort to go by the rules of " quality care" and properly document them so the reimbursement  will be 3 or 4 % more or less ( see here) and less available to do what is needed to help the patient.

Addendum; For an excellent  review of how MACRO will change just the "Meaningful Use" program (and there is much more to it than that) see here.

 h/t to Margalit Gur-Arie on her blog "On Heath Care Technology"

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