Charlie Baker hits the nail on the head, on why costs are absent from the political debate: “It’s easier to talk about doing more things for more people than it is to talk about taking costs out of the system.”
Most proposals focus on reforming the physician payment system, and turning back the clock to embrace capitation.
That sounds great in theory, and I bet many generalist physicians will go for it, but the real challenge is to convince patients to remove the foul taste of capitation from their mouths.
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Count this family physician out. I want no part of a system which puts the patient and physician’s interests in even more conflict.
HSAs do a much better job of controlling costs for patients above the safety net by giving them control and responsibility for their cost decisions.
Capitation: tried that, been their, and have the T-shirt–both as a patient and as a physician. Ultimately it puts patient and physician interests on a collision course.
Direct payment is the best way to preserve the doctor-patient relationship and to control costs–which are themselves largely a product of third party payment.
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