Posted on 01/26/2015 9:14:39 PM PST by Nachum
There should be a law... where all of Congress, the Judiciary and all minor court officials, and the Executive branch and minions have to live under any law they pass for a decade before foisting it on the citizenry.
I have had that exact conversation with a friend’s wife who is an MD.
She is an extreme leftist, supported Obama care and just does not believe her salary will be under attack in the future.
It will.
So doctors will have a financial incentive not to have anything to do with people who are not reasonably healthy.
the government will also evaluate whether patients are healthier, among other measures.
how is a doctor gonna make the patient be healthier? This is the Patients responsibility.
The word “policymaker” should only apply to 100 senators and 435 congressmen. Anyone else that considers their job within federal government as “making policy” should be perusing the classifieds.
I'll tell you, at the risk of upsetting some attorneys that might be on this site. The fact is that many attorneys resent physicians, and attorneys happen to be very well represented in American government (e.g. Obama, the Clintons, a ton of people in the Senate and Congress). There are lots of honest attorneys with high ethics and a desire to do good, but by and large attorneys have a lesser degree of trust and stature among the public than do physicians. That's just the way it is, fair or not.
Add to that the fact that one of the most compelling reasons that drives people to run for public office is that they have components of narcissism, grandiosity, and the need to ‘get credit’ as big parts of their personalities, and you have the perfect formula for attorney politicians, like Obama, resenting physicians. It's just a fact.
The problem is that in their zeal to ‘knock physicians down a peg, or two, or three etc.’, they keep hurting the people physicians are trained to help.
Quality measures are very, very, very flawed, and if they progressively tie a physicians ability to make a livelihood to government-defined outcomes measures, what will happen is that you will see rationing of care by physicians. If I am going to be ‘judged’ and paid on the basis of outcomes, and they are going to judge my quality of care on this basis, it becomes in my best interest to avoid taking care of patients who are likely to have poor outcomes (e.g. the significantly elderly, those who have genetic or lifestyle-related contributors to a worse outcome etc.).
If you do surgery/procedures, you aren't going to do high risk procedures anymore, because it will just decrease your ‘quality score’. So those with the most advanced and challenging disease burden will find it harder to get treated. Instead, these people won't get procedures and surgeries, but will be treated ‘conservatively’. This will make the government happy, because it will cost less, and the blame for rationing will have been shifted to the physicians.
This is a very accurate real life example: A man who is out shopping has a heart attack because of an occluded coronary artery. He had some chest pain, but thought it was heartburn, so didn't seek urgent medical care. Unfortunately, because his heart muscle isn't getting enough blood flow, he has abnormal electrical activity in the heart (an arrhythmia) and suffers sudden death. He is found down in the aisle of the local grocery store, and one of the customers knows CPR and starts resuscitation.
The store manager calls 911, the EMTs arrive, and the man is ‘shocked’ into a normal heart rhythm. They also place an endotracheal tube to ventilate him better. He remains unconscious, and no one is really sure how long he was ‘down’ before the CPR started, or whether or not he is likely to have severe brain damage or brain death. When he gets to the emergency department of the nearby hospital, an ECG shows that he is having a heart attack.
A cardiologist is called, to see if the patient should be taken immediately for a procedure to open his blocked artery and stop his heart attack. The cardiologist knows that the statistics regarding survival after an ‘unwitnessed’ out of hospital cardiac arrest are poor, and that this man is likely to die. He also knows that if he takes the patient for a procedure, opens the patients blocked artery, but the patient then goes on to die within the next day or two, the patient’s death will be linked to his procedure (statistically), and will count against him as a peri-procedural death. In Obama’s world, this will mean that this physician's ‘quality rating’ will go down, and by doing the right thing (stopping the heart attack, hoping that the patient did not sustain brain death prior to reaching the hospital, and giving the patient the best chance) this physician will risk his ‘statistical’ quality score-based reputation.
Some physicians will choose to say, ‘to hell with the statistics, I'm going to give this man the best chance possible to live’, but some may choose otherwise. They will use ‘statistics’ to rationalize their inaction, and their personal statistics will look better because of their choice. Are these really the ‘highest quality’ physicians? I don't think so.
It's all really kind of sick.
Expect doctors to leave the field en masse. The government will find its just cheaper to kill the patients after taking their premiums rather than pay their claims.
Almost as great as Multiculturalism and Diversity.....
That model will have to change once medical students take smart decisions to pursue investment industry or banking instead of medicine. Government will begin to finance medical education similar to how it now funds its military academies - no cost in exchange for a stipulated period of service at a location and specialty the government assigns.
Lets impose this new fangled model onto unionized Teachers, and analyze the results
I would expect that some Doctors depending on age and their practice will not be impacted too much.
Those impacted the most will be those in Medical school now, or those who are just beginning to enter the market.
Geriatricand ER doctors will leave medicine in droves. No one will work with elderly or seriously ill patients. They’ll all become dermatologists.
Some physicians will choose to say, ‘to hell with the statistics, I'm going to give this man the best chance possible to live’, but some may choose otherwise. They will use ‘statistics’ to rationalize their inaction, and their personal statistics will look better because of their choice. Are these really the ‘highest quality’ physicians? I don't think so.
AH HAH! And therein lies the rub. This will pad the stats of all the crappy doctors that will have to be imported from 3rd world countries in order to maintain decent physician/patient ratios.
Essentially, you will have a pool of physician stats on the line of government economic statistics. Like ground chuck being substituted in inflation stats, and unemployment lowered by dropping the year+ jobless off the stats, you'll be informed treatment has NEVER been better while watching your fellow Americans increasingly suffer from crappy healthcare.
Make a deal with Satan and expect to Not get burnt?????????? Ha!
No, doctors will make more money as lawyers.
Atlas Shrugged was supposed to be a warning, not a blueprint.
“Let them discover the kind of doctors that their system will now produce. Let them discover, in their operating rooms and hospital wards, that it is not safe to place their lives in the hands of a man whose life they have throttled. It is not safe, if he is the sort of a man who resents it - and still less safe, if he is the sort who doesn’t.”
Tick, tick, tick...
If you’re not already prepping, you might want to start.
Love,
O2
The assumption that “quality” of care is the entire responsibility of the doctor only shows ignorance. At best patient compliance is 50 to 70%. Hell, I AM a doctor and I don’t think I have ever taken all ten days of a twice daily antibiotic. Make it three or four times a day and compliance gets even worse. Just getting people to keep appointments is almost impossible.
I just remembered what my 85 year old aunt said recently: “I hope he takes a trip to Dallas and keeps the top down”.
Very good point! I had a diabetic uncle who wouldn’t stop eating candy (especially his beloved salt water taffy) and the like, no matter how many times his doc told him he had to start taking care of himself. Unk’s sugar counts were always way out of wack and he ended up getting all the “benefits” of uncontrolled diabetes, including gangrene in one of his feet. Not the doc’s fault at all, but it could very well shown as that with what’s being proposed.
Again, great post!
They want a merit-based pay system when death is always a possible outcome. Sounds like doctors will have to opt to only take care of the healthy.
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