If the government was a physician

If the government was a physician, it wouldn’t be an ordinary doctor like you or I.

It would be a sexy actor like the ones we see on those medical melodramas that have become so popular over the last few years.  His hair coiffed, his jacket pressed and free of stains, and his manor confident he would rush into the trauma bay.  As the beeping monitor flat lines, he would sweep the nurses and residents out of the way, grab the paddles, and shock the poor patients heart back to life.  The wife and children would rush in and profess love to their newly awakened father.  And the super cute head nurse would glance appreciatively at our hero and wink with not so subtle romantic overtones.

Of course, any one remotely involved in health care knows that this is a farce.  Wipe away the syrupy made for TV moment and what we are left with is one simple medical fact.  You don’t shock asystole, it’s useless.  Such subtleties are often lost on those who shape today’s health care policy.  And who could blame them?  Most are politicians, administrators, or physicians who have long forgotten the practice of medicine.

Given the set of circumstances, the ACA is more sophisticated than it first appears.  In fact, much credit must be given for the emphasis on demonstration projects.  This is basic scientific method at it’s best.  Try a bunch of ideas and see which stick.  I couldn’t be more in agreement.

To Medicare’s great embarrassment, recent demonstration projects have shown little measurable benefit for the lynch pins of health care reform: pay for performance and patient centered medical homes.  There is no doubt in my mind that the same will eventually occur with ACO’s.  The problem arises, however, that in Washington, political expedience often carries more weight than courage.  In other words, it may be of no benefit whatsoever to shock asystole, but when the film is rolling, the defibrillator paddles are charged and ready.  It’s a million dollar fundraising moment.  Politicians like these.

But when the lights are turned down and the cameras shut off, we are left with a doctor who knows nothing of the practice of medicine and a health care system wrought with perverse incentives.

We need the real thing.

Not just someone who plays a doctor on TV.

Jordan Grumet is an internal medicine physician who blogs at In My Humble Opinion.

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