walkitout (walkitout) wrote,

doctors and decision making, or, our money and our lives

This kinda set me off:


It's long, and there are some doozies in it. They complain about political obstacles to saving money on health care and devising reasonable regulation. Given these two folks stance on litigation (gleaned from other stuff published over the years), I wouldn't trust them on any topic, either. They seem to subscribe to the theory that if you got rid of litigation, you would eliminate the motive for defensive medicine/overtreatment. Hardly.

"One approach: We urge development of small clusters of primary care doctors and other professionals that live within budgets, accepting capitation payments calibrated to patients' health. Raising primary care doctors' incomes by half would sharply increase their supply and their time to listen to patients and coordinate care."

Sure. That's gonna work. Look, MDs are fabulously well known for being like among the _stupidest_ people when it comes to finances in general. Doesn't matter whether you look at how they run their household budgets, their retirement planning, investment decisions in general or running their business (their practice is a business). As a group, I don't think they can be beat for being dumbshits with money. This just does not pass the sniff test on that account alone.

Second, doctors don't have to be sued to practice defensive medicine or to overtreat. If docs are passing out scrip for antibiotics for people with colds and _relying on media_ to convince people to _quit asking_ for scrip for colds, it seems obvious that these people have spines about like jellyfish have spines. They _cannot_ say no, consistently, as a group. Does not pass the sniff test on that account as well.

But just as a little example, here's what might happen if you had a small cluster of primary care doctors making decisions about health care based on financial repercussions:


Here's a sample of what you'll find in this long -- but worthy -- entry:

"I went for a job interview in Portland and in a conversation with the medical director of a large group there, I was told that if I failed to get my patients LDL levels down to 100 “someone will sit down and talk with you.” This particular group was able to offer a better starting salary than average. I had assumed that the reason they could offer more was through efficiencies. During the interview, I learned there was more to it than that. They had special arrangements with drug companies called ‘incentive programs.’ The medical director told me with absolute glee “we keep asking them [meaning drug companies] for money and they keep giving it to us.” He sounded like a kid at Christmas!"

This sounds like a _great_ idea.

There are a variety of ways to tackle this particular funding conundrum, some of which might work. What Socolar and Sager are proposing doesn't strike me as one of them.
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