There really is no war on doctors: There’s a war on patients.

So you think there is a war on doctors, don’t you? It certainly looks that way from your particular vantage point. The government is deftly intruding into your professional life with a computerized fifth column that is extracting information on your every move, and to add insult to injury, it forces you to actually collect the data which is to be used against you in the court of public opinion. Media outlets are stepping all over each other to be first in line with sensational headlines implying reckless abandonment to greed in a profession believed to hold higher ethical standards than most. And the ever louder calls to rein in the seemingly rampant waste, fraud and abuse in health care, are becoming synonymous to reining in doctors’ irresponsible conduct.  The art of rabble rousing has always included oblique references to how the mighty have fallen. What is unique about the modern day twilight of the doctors is that it has practically nothing to do with the doctors themselves.

There really is no war on doctors. There is a war on patients, and doctors are merely collateral damage. You are an exploitable asset, to be bought and sold like cattle, and with you, the “covered lives” that you “control.” In a perfect world the price of acquisition would include orderly transfer of said control to the new owner, but the world is not yet perfect, so for the time being you must be retained as a proxy for the controlling interests in covered lives. You will have to learn new skills because the management of many covered lives is different than the management of the few, or the one. You will be held accountable for the health of your populations, and you will need to exhibit financial stewardship of the scarce resources allotted by the owners. In other words, your job now is to increase the productivity of the covered lives assigned to you, at the lowest possible cost to your employer, and the clients of your employer. These are classic key performance indicators (KPIs) in any business, and health care is no different.

The established leadership of the medical profession is currently on an all-out crusade to prepare the rank and file for their evolving position in this new world order. In April, NEJM published the recording of a roundtable discussion, moderated by Dr. Atul Gawande, which concluded with the heralding of a “new culture in practicing medicine” where doctors “prioritize our responsibilities as shepherds of scarce social resources to the same extent that we’ve historically prioritized our responsibilities for providing benefit to our specific patients.” To reinforce the argument, Dr. Peter Ubel, in an opinion piece titled “Promoting Population Health through Financial Stewardship,” is proposing to take the ABIM Choosing Wisely campaign to new levels and have doctors “contemplate trading off small clinical benefits for individual patients in order to promote more general societal welfare.” Since institutions have a business imperative “to reduce the amount of care they provide to patients” because of new payment models, Dr. Ubel keenly observes that, “If physicians resist these efforts because they feel they owe it to their patients to provide the best care regardless of costs, hospitals may look for other ways to trim expenditures, such as by reducing nursing staff.” If you are a doctor, and especially if you are a patient, the enormity of this statement should give you monumental pause.

Why wouldn’t hospitals auction off original artwork hanging in the lobby instead of firing nurses, is largely beyond me, but this particular flavor of financial stewardship, which is benefiting society by limiting clinical benefits available to its members, is all the rage now. Did you ever wonder why insurance companies seemed to not mind Obamacare requirements to place no limits on lifetime or even yearly maximums? Wonder no more. Recently, the American College of Cardiology and the American Heart Association published the “ACC/AHA Statement on Cost/Value Methodology in Clinical Practice Guidelines and Performance Measures.” It seems that clinical guidelines are going to sport new value ratings that can be used to inform insurers and policy makers engaged in coverage determinations. Based on the World Health Organization (WHO) methodology, spending over $150,000 per quality adjusted life year (QALY) will be designated as low value care. The American Society of Clinical Oncology is working on its own financial stewardship guidelines, coming soon to your iPhone. Obviously insurers could just restrict coverage based on these ratings, but oh how much better it would be if doctors just refrained from prescribing these treatments on the QT.

For their part, distinguished economists, who practice their dismal science in the health care domain, are also searching for tools to help doctors manage their assigned populations. Writing for the New York Times, Professor Uwe Reinhardt is lambasting Congress for its reticence to assign formal monetary value to the lives of people. There is implicit bulk valuation when covered lives are transacted, of course, but what you need at the bedside is patient-centered, personalized value estimates for each patient profile. How else will you decide if there is acceptable ROI when contemplating small clinical benefits? There is a rather humorous exercise in demagoguery, mistakenly attributed to George Bernard Shaw, which states that our seemingly moral convictions are not based on principles, as much as they are based on the amounts paid to us for transgressions. Following this irrefutable logical argument, Prof. Reinhardt is suggesting that it’s time for Congress to stop feigning indignation, and that it should take a lesson from the venerable Milton Friedman and put a price on every human head.

Walmart is promising to bring organic food to the masses. Walmart will make organic food affordable for the poor. What a wonderful idea! For Walmart that is. Small organic farmers are going to be forced to accept cheap Walmart prices and increase their “productivity,” or agree to sell their farms to industrial farming corporations. Maybe former organic farmers can get a job at Walmart, stocking shelves with pseudo-organic foods. Before you know it what passes as organic foods will be as lousy as regular foods, only a bit more expensive. Walmart is the future of all commerce because Walmart doesn’t just sell cheap replicas to unsuspecting poor people. Walmart is also nurturing and growing the poverty necessary to attract new customers. And this travesty is precisely the model chosen as the blueprint for fixing health care in America.

Caveat emptor

For the longest time now I was of the opinion that the entire patient engagement movement is much ado about nothing, either stating the obvious, or demanding the impossible. I changed my mind. The emerging realities of health care in the U.S. are rendering patient engagement imperative, except for those patients who are participating in programs like, say, Penn Passport, a Penn Medicine product advertised as “a great resource for people who value their health care,” which includes Pavilion services complete with “warm cherry cabinetry, soothing earth-toned fabrics, comfortable elegant furnishings and convenient in-room safe” (the safe did it for me). For all others, it will be up to each and single one of us to advocate for ourselves in an essentially adversarial system. Perhaps a new profession will emerge, and perhaps patients would be best advised to bring an attorney to the exam room.

Dear Mr. and Mrs. Average Patient, since you are unwilling or unable to properly value your health care, the system will do the valuation for you. To ensure that the services you receive at industry venues are clinically appropriate for your situation, you must engage in independent and sustained research of your condition. This is particularly important if you are poor, old, disabled, very sick, or illiterate. Most of your research can be done on the Internet. If you can’t afford a computer, the public library will provide one for you. If you don’t have a car, most buses will have a stop in proximity to a public library. It is imperative that you keep notes and actively question all therapies offered to you and most importantly, those that are not. You should insist on real-time, online access to your medical records. Not some generic summary, but the full notes outlining the thoughts (if any), differentials and considerations made by those in charge of shepherding your scarce resources.

You could try to find a tiny private practice that is “in-network” with your insurer and pray that they take new patients, or you could scrounge together a few dollars, and go find a cash-only physician that may be willing to advocate for you. But the best thing you can do is to take a more expansive approach to patient engagement, and stand up for yourself and your family in this abject, immoral and underhanded war on the American people. The only thing that stands between you and cheap pseudo-medicine that looks fine from a distance, and full of holes upon closer inspection, is your doctor. No, doctors are not saints, and a few are outright villains, but taking away the ability of your doctor to exercise independent judgment on your behalf, is not intended to benefit you, or society for that matter, unless by society, you mean the six Walmart heirs, and their peers. You may be tempted to think that physicians are wealthy enough and powerful enough to ward off attacks from without and from within on their own. You would be very wrong. And is this really a health risk you are willing to assume? It’s time to engage.

Margalit Gur-Arie is founder, BizMed. She blogs at On Healthcare Technology.

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  • Arby

    I couldn’t agree with you more. It is also why I do not want single payer. Once government gets involved it is game over with no choices and doctors towing the line to whatever metric they write.

    I have seen people behave like lambs to the slaughter on any number of issues. Do I expect them to rise up for this issue. Sadly, no.

    • Dr. Drake Ramoray

      You took the words right of my mouth.

      http://content.time.com/time/health/article/0,8599,1888006,00.html

      The very same thing is happening here, except the American way through crony capitalism and physicians denied the right to collectively bargain and pay for performance. Other countries, less crony capitalism, physicians can collectively bargain, and it’s fees for service. If the US continues down the current path it may be better to work overseas as a physician.

      • http://onhealthtech.blogspot.com Margalit Gur-Arie

        …not just as a physician… Although as a physician, your options are much better than most other professions, except maybe technology guys….

        • Dr. Drake Ramoray

          I know it’s not just docs. Many other professions have witnessed in the past what is now happening to medicine. We are actually pretty late to this game. I have several plans in the works that I have discussed before so I won’t bore you with repeating the details.

          • Patient Kit

            My new plan is to just give up on healthcare, let nature take it’s course and go die like a wild animal on a beautiful uncrowded beach in Mexico, too young but happy. No insurance, hospitals, doctors, medication or huge amounts of money necessary. Simple.

          • ninguem

            Remember Kit, when on that beach.

            Spend every last penny you have on yourself.

            The last check you write, goes to the funeral home.

            …..and it bounces

          • Suzi Q 38

            Believe it or not, I am tempted to agree with you.

    • http://onhealthtech.blogspot.com Margalit Gur-Arie

      I differentiate between systems like the NHS or Kaiser or the VA, and systems where the payer is not also the provider of care. The better systems are just single collector (of taxes), while care delivery is largely private, with heavy price regulation and no profit taking allowed by third party administrators.
      I may be wrong, but I think this provides some checks and balances on the collector/payers and healthy incentives for the delivery guys to excel.
      It’s still not cheap, but why should it be? I’m fine with health care and scientific research being the big items on our budget. I really don’t know what other options there are…. and I am acutely aware of the fact that a corrupt “single collector” could create huge risks for the people.

      • Arby

        I see what you are saying. I generally think of single payer as everyone working for the government aka NHS or communist Russia, so thanks for pointing out the difference.

        Still, he who has the gold will write the rules, even if it is our gold to begin with. Funny how that works.

        • http://onhealthtech.blogspot.com Margalit Gur-Arie

          Agreed. Any way we look at this thing, it comes down to having to fix our political system before we do anything else…..

  • QQQ

    “Obamacare requirements to place no limits on lifetime or even yearly maximums?”

    Harry Reid called a lot of American’s liars for telling the truth about the nightmare ACA . How many Democrats or even Hillary stood up in our defense and said ..Whoa Harry , Slow down man , You’re out of line .

    That tells me that they themselves either agree with him or that they are too afraid to stand up and defend us. Well Harry was out of line and Harry has himself lied on many occasions along with Hillary and the other Democrats .

    Today a lot of hard working Americans , who has paid their dues in taxes are afraid of what tomorrow will bring , they are unsure of where that already paid for meal is coming from . If they will have a doctor tomorrow or if they can even afford a doctor visit . Not to mention where they will live the day after tomorrow . Ask yourself a some question’s . Does Harry Reid , Hillary Clinton or Nancy Pelosi have those same fears ?

    Are they feeling unsure of what the day after tomorrow will bring? The answer to that is easy , No, they fear nothing because they have set themselves up to be taken care of with your tax dollars while the rest of you can just starve .They have lied , cheated and stolen your tomorrow .

    • http://onhealthtech.blogspot.com Margalit Gur-Arie

      I would just add that this is true for all the crooks on both sides of the isle….

  • DeceasedMD1

    “You are an exploitable asset to be bought and sold like cattle”

    This sounds pretty much like the new economy that capitalism is now based upon. It’s no different than being on Facebook or pick your site. You are not the consumer. You just think you are. You are being bought and sold to various advertisers. But the masses think that they are getting a service for free or do not understand what all the fuss is about.

    The system is quite Darwinian set up to prey upon the vulnerable. It seems this theme is everywhere you turn these days. The lure used is some mass marketing strategy of being “free” or convincing one that they need your help. Marketers are now not just on tv. They are calling people’s homes with offers for free FDA approved medicine, medical devices ,etc. Gee how did they get the pts data/phone number to match what they needed before they even realized it themselves? Now the pt can be passive and just wait for the phone to ring.

    Unfortunately I think in part, the way they reach the masses is marketing manipulation. Most things are free or the commercial let you know they are concerned about your medical problem and have a solution.But of course medicine is only a matter of life and death.

    • Dr. Drake Ramoray

      The patients will be like cattle,’but so will the algorithm following providers. Things like it will be “unethical” to retire will be just the beginning. See my comments here.

      http://www.kevinmd.com/blog/2014/06/retiring-medicine-become-ethical-issue.html

      • DeceasedMD1

        Hopefully medicine will not become a new form of slavery. Come to think of it…

    • Arby

      I read a study recently that found a correlation between commercialism and declining empathy. So, yes, I think you are on point with the marketing madness.

      • DeceasedMD1

        Just curious. Do you recall where you read that? It sounds spot on.

        • Arby

          I wish I could. I get daily Feedly and Medical News Today streams, but when I went looking for it I could not find it. It bugs me as I saw it within the past two weeks. If I find it, I will be sure to let you know.

          • DeceasedMD1

            no worries. sounds interesting though.

        • LeoHolmMD

          I recommend the documentary “The Corporation”.

          • http://onhealthtech.blogspot.com Margalit Gur-Arie

            Fantastic! Thank you so much for the excellent recommendation.

    • http://onhealthtech.blogspot.com Margalit Gur-Arie

      It is truly amazing how much effort is now going into basically selling junk to people. Almost everything new in tech is built on the premise of “monetizing” data.
      One can only dream about what could happen if we put all this effort, and cash, into something more worthwhile…

      • DeceasedMD1

        Seems like this data monetizing as you put it, has been increasing more in the last few years, coinciding nicely with ACA. No wonder they were so happy to have it pass. One wonders how Obama could have missed that part.

    • Patient Kit

      People need to stop being sheep, willingly giving their email address to advertisers in return for a flimsy chance to win something questionable. People need to stop being Pavlov’s dogs, salivating at inboxes full of daily emails from Amazon, Land’s End, Walgreens, etc. People need to stop counting celebrities and advertisers as among their closest 5,000 “friends” on Facebook. People need to stop being Homer Simpson, reaching for the donut and getting shocked over and over and over but still going back for more. We’re not pure cattle.

      • http://onhealthtech.blogspot.com Margalit Gur-Arie

        I often wondered how we got to this point… I think there are several factors at work here. First, this is all happening slowly, in small increments, and by the time we figure out what the deal really is, it’s too late. Second, I think people can’t really afford to pay for all the niceties so abundantly available and so richly advertised all over the place, so free seems like the only option to keep up with progress. For many things on the Internet, there are no common not-free options (browsers, email, social media…).
        Lots of technology folks are very militant about software being free, but what they seem to overlook is that there is labor involved in making software, so either someone works for free, or someone gets paid by someone else. This is not too different from health care actually, where the traditional buyer/seller market theories are breaking down, and not to the buyer’s advantage…. Maybe even in general, there is an indirectness to the way we do things now that is very confusing and very fertile ground for fraudulent behaviors. Even in local, low-level politics… it’s all a tangled web….

        • doc99

          It all began when 3rd party payors entered the picture – the patient was no longer the client.

      • DeceasedMD1

        I am also amazed at this. Sitting next to someone on a plane who was getting “free wifi” by giving out his data. I asked him in a nice way if he was aware of the implications, but he did not seem to care because it was “free”. You make a good point that the public is allowing this. If they did not put up with it, there would not be such a growing market for it. Unfortunately, it requires one to be introspective and think about the consequences of this, which few are willing to do. It is also done so covertly. The average person is unaware of data warehouses or how it affects them. If they are later discriminated against in some way, they do not have a clue where it came from.

        • Arby

          Many young people give fake information. I try to avoid it because things that aren’t truthful even if harmless still bother me.

          • DeceasedMD1

            true but do you that data brokers are pretty sophisticated and conglomerate a picture from multiple sources? I really don’t know the answer as there is no transparency.

  • ninguem

    Walmart Organic.

    I just got some dried vegetables at Walmart.

    One was dried okra, the other a mixture of dried squash, beans, other vegetables.

    I usually get the same product from a farm in Dayton, Oregon. Pictured below.

    They distribute all around the area, I’ve seen it selling from their farm as far out as Seattle.

    Dang. I didn’t notice until I got home.

    Product of Vietnam.

    Perfect copy.

    I wonder if they use political prisoners for fertilizer.

    http://i1.ytimg.com/vi/pI7FvkvtFg0/maxresdefault.jpg

    • http://onhealthtech.blogspot.com Margalit Gur-Arie

      Oh wow, it started already….
      On a slightly different note, a few days ago Stephen Colbert had a Silicon Valley baby entrepreneur, who obviously doesn’t watch old movies, showing off his innovative product, a complete food replacement in liquid form, and he named the darn thing…. Soylent….. it wasn’t green though :-) I don’t think it was a joke either….
      http://thecolbertreport.cc.com/videos/2kgoki/rob-rhinehart

      • DeceasedMD1

        IT’S ALIVE!! IT’S ALIVE!! I especially liked the prison story about the Debt penalty.

    • Patient Kit

      What is this Walmart of which you speak? We don’t have any Walmarts here in NYC. They’ve tried and tried to get in here but, so far, we have defeated Walmart’s every effort to infest here. Of course I’ve heard of Walmart but I don’t think I’ve ever been in one. And, yes, I do get out of the city sometimes. But Walmart has never been my chosen destination.

      • http://onhealthtech.blogspot.com Margalit Gur-Arie

        New Yorkers must be very smart people…. :-)

      • guest

        We have both the “Fresh Markets” AKA Walmart grocery stores and full on Walmarts. The Fresh markets actually do a nice job of putting produce and healthy options at the front of the store. That said, on a recent visit I didn’t find the prices to be much more reasonable than those at my “rich” neighborhood grocery store.

        We have a lot of welfare here in CA so of course we have a lot of Walmarts. Interestingly, I do not find the prices to be that amazingly low.

    • Arby

      Unsolicited advice: Don’t buy anything at Wally World that is not a brand name food product. Brand name stuff may sketchy as you don’t know what deals they made with them, but the risk is much smaller than with the rest of the food products there which are definitely sketchy. And, forget the meat they carry; it is nasty.

  • Thomas D Guastavino

    Wow. As a retiring physician, there is only one thing left to say.
    “Who is John Galt?”

    • Dr. Drake Ramoray

      Congrats on the retirement, while it’s still “ethical”. How much did the changing landscape encourage you to retire? One of the local opthos retired just a bit ago. His speech at themed staff meeting was basically. Times have changed, good luck suckers.

      • Thomas D Guastavino

        The last straw for me was when I as a fee-for-service supporting physician was not only accused of being complacent with but actually causing complications for financial gain.

        • Dr. Drake Ramoray

          Unfortunately I’m not old enough to retire regardless. Although in a few years when the kids are older my family will have other options.

          As I don’t have much in the way of procedures that have complications (the thyroid is full of iodine after all so FNA complications are basically unheard of) I only get the complacency/apathy pay for performance argument. Actually being accused of causing complications for financial benefit is indeed a deal breaker.

    • DeceasedMD1

      Good idea. If we all quit, the medical industrial complex could just use the algorithms they have created to practice medicine.

  • Patient Kit

    If we are going to put a price on every human head (and by we, I mean they), the few with the money and power will, of course, value themselves most highly and the rest of us will be deemed worthy of the remaining 1% of healthcare resources after the few most valuable and deserving heads use up 99% of our healthcare resources on themselves.

    To this I say we (and this time I mean the real we, the people) should shout “off with their heads” and show those greedy selfish ******** the true value of their own heads with the guillotine.

    >:-(

    • http://onhealthtech.blogspot.com Margalit Gur-Arie

      Just vote them out of office…. For many of them that is probably a worse fate than losing their heads :-)
      I am actually in awe of what happened to Eric Cantor. I obviously don’t agree with the guy that beat him, but to see someone come from nowhere, with no money, and thoroughly whip a powerful incumbent is invigorating.
      We should start our own Latte Party with the sole objective of reforming campaign financing…

      • Patient Kit

        It never ceases to amaze me how many Americans don’t vote in any given election. Voter turnout is shockingly low even for presidential elections.

        • http://onhealthtech.blogspot.com Margalit Gur-Arie

          not to mention primaries….

  • Rob Burnside

    Bravo Margalit, and welcome back. I think you may be John Stuart Mill reincarnated.

    • http://onhealthtech.blogspot.com Margalit Gur-Arie

      Oh no, not even remotely in the vicinity of the old man….:-) He did have some terrifyingly prescient thoughts though….

      • Rob Burnside

        Alright, then–Maud Gonne.

        • http://onhealthtech.blogspot.com Margalit Gur-Arie

          Okay… you got me there. I had to look her up :-)
          I think I would have enjoyed being a “revolutionary” in the olden days. I don’t think we’ll be having too many revolutions in the future, and I don’t count the garden variety civil wars in places playing catch up with the 21st century….

          • Rob Burnside

            Your modesty belies your ability, as a writer and a thinker. Many of us can’t walk and chew like you!

  • ninguem

    And this [Wal-Mart] travesty is precisely the model chosen as the blueprint for fixing health care in America

    Wrong, Margalit.

    It’s Cheesecake Factory.

    Don’t you follow KevinMD ?

    • Patient Kit

      We don’t have any Cheesecake Factories here in NYC either. I’ve never been in one. We do, however, have very good cheesecake here.

      • Arby

        Cheesecake Factory is highly overrated. Keep the small bakeries; they do it much better.

    • http://onhealthtech.blogspot.com Margalit Gur-Arie

      Oops… sorry. You can buy Cheesecake Factory poison at Walmart now, so same thing basically….

  • Arby

    Well, not every patient. I own my own health to include researching everything, and I try to spare my physician grief by getting screenings I don’t even believe in and, recently, filing my own appeal with my insurance company over a med denial. Not that my physicians haven’t helped me out with forms on short notice before, but I really do try to keep their job to only my medical care.

  • Arby

    I already think this will happen, except for insurance companies falling under the weight of the sick. I think they will find more creative, legal ways to abandon them and then everyone will want the gov’t to run things as if that would be better. It will be at first and then it will end up a hot mess like everything else they touch.

  • Joe

    About a year ago, I read in a blog somewhere the comment that our current health care policies are on track to lead us somewhere between Logan’s Run and Soylent Green. It’s actually what led me to KevinMD. Even working as I do, I didn’t believe it then. I really thought we, as an industry and as a group of professionals, would change things. I don’t anymore.

    • http://onhealthtech.blogspot.com Margalit Gur-Arie

      I share your conclusion, Joe. I started out very hopeful as well, and here I am today….

  • MrsDoc

    A war on patients? A majority voted this upon themselves, twice.

    • http://onhealthtech.blogspot.com Margalit Gur-Arie

      True, and I am one of them…

  • http://onhealthtech.blogspot.com Margalit Gur-Arie

    Yep. It is…. The way I see it, finishing off the docs is a prerequisite for the larger objective

  • http://onhealthtech.blogspot.com Margalit Gur-Arie

    My preference would be for everyone to pay to the best of their abilities into a system of financing that will cover everyone to the extent of their needs. Unfortunately, I am often told that this is some sort of communism. I disagree. I think it’s just common decency.

    On the question of who started this thing, I don’t think it was the doctors in general. The reason they all “charge” those inflated prices is purely administrative and derives from the multitude of ever changing fee schedules they have to deal with and the legal requirement to charge all patients the same baseline fee. Nobody is expecting to actually collect those fees, and this practice is really messing up their accounting systems.

    In my opinion, what really derailed the whole thing, was doctors acquiescence to being employed and managed by non-physician owned hospitals. You have to remember that most of the money for surgeries and hospital stays goes to the hospital, and only a small fraction goes to the doctor. Sure, most hospitals are set up as “non-profit” corporations, and lots of insurers too, but everybody is for-revenue, and for empire building… That’s where the bulk of our money is going.

    What physicians need to understand, and I am not sure they do, is that their personal fortunes are tied to the fortunes of their patients, not to the fortunes of their wannabe masters, or whoever else is meddling in this thing….

  • http://onhealthtech.blogspot.com Margalit Gur-Arie

    Agreed… or any activism at all ( I am open to suggestions :-)
    Better than just sitting there like the proverbial deer in the headlights…

  • Natasha

    Trying to put a price on a human life is appalling. However, policies that might inspire healthcare providers to back off of all of the useless and harmful therapies they sell, and to look more carefully at the evidence before recommending them would be a good thing.

    Some relevant reading:

    http://jama.jamanetwork.com/article.aspx?articleid=1104821

    http://www.mayoclinicproceedings.org/article/S0025-6196(13)00403-5/references

    http://www.theatlantic.com/magazine/archive/2010/11/lies-damned-lies-and-medical-science/308269/

    http://www.ncbi.nlm.nih.gov/m/pubmed/24819404/

    • http://onhealthtech.blogspot.com Margalit Gur-Arie

      Of course…. I am a huge fan of Dr. Ioannidis. But this has more to do with how research is done than actual delivery of care, and perhaps this is exactly why many practicing docs are balking at the idea of mandated guidelines and “quality” measures….

  • campykid

    I consider myself an engaged, informed patient. My health insurance is through an HMO (the better of two limited choices) and after reading this article I am even more afraid of the healthcare industrial complex.

  • KzooPost

    Why wouldn’t hospitals auction off original artwork hanging in the lobby instead of firing nurses, is largely beyond me…[?]”

    I would add, or reduce CEO and VP salaries, and the answer is easy, viz, because they don’t have to. Nurses and ancillary staff are willing to work for less, as are doctors. I’m sure there is some economics term for this: (“labor deflation”?)

    “Dear Mr. and Mrs. Average Patient, since you are unwilling or unable to properly value your health care, the system will do the valuation for you.”

    Well, duh. How does an average patient know what the standard of care is. This is called asymmetric information and it’s rampant in a lot of fields and products. How do you know that the water coming out of your kitchen faucet is safe to drink? Does Mr. and Mrs Average Water Drinker test every glassful?

    Medicine should be run like a utility: we all need it and the product should be of the highest quality. Don’t worry, even utilities employ engineers and technicians that make a good living, so we doctors and nurses will still be paid for our expertise.

    • http://onhealthtech.blogspot.com Margalit Gur-Arie

      You make an interesting point about nurses and doctors being willing to work for less, and it occurs to me that the armies of executives, many with no specific qualifications, would be even more willing to work for less, if there was a higher authority forcing them to do that, instead of having them decide how much to pay themselves. I bet we could find outstanding CEOs for a fraction of what they are paid now. At one time nuns used to run hospitals, and I personally know of at least one that was better than anything replacing her….

  • KzooPost

    It’s a war on cost, with 17% of the GDP going to health care. Unfortunately, doctors don’t have a voice to advocate their cause, unlike the strong lobbying groups for big pharma, hospital corps, and health insurers. Cutting doctors reimbursement is easy.

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