Saturday, October 17, 2009

Obama's Ratchet

"Doctors are trying to remove a provision in the Senate's latest health care bill that would cut Medicare payments to those who administer the most tests and treatments. The proposal--aimed at reducing waste--is one of several proposals in the bill by the Senate Finance Committee that could change how doctors are evaluated and paid. ... The bill calls for the secretary of Health and Human Services [SHHS] to account for doctors with less-healthy patients. But the government has acknowledged that its efforts to collect that type of data haven't fully accounted for all the attributes of Medicare recipients. ... Democrats see the health overhaul as a chance to reward doctors on the quality of care rather than the quantity. Health policy experts say the change is critical to eliminate wasteful medical spending. The Finance Committee bill would require the [SHHS] to distribute reports to doctors that compare their levels of treatment to other doctors with similar patients. Any doctor whose level of testing and procedures ranked at the 90th percentile of above would be penalized with 5% reductions in Medicare reimbursements. ... Republicans said the bill would hurt patients. 'This is, pure and simple, the rationing of health care," said Senate Republican Whip Jon Kyl of Arizona", my emphasis, Janet Adamy at the WSJ, 2 October 2009, link:

Ad hominem attack notice: Who do you think you're fooling, you mollycoddled, affirmative action baby, POTUS Obama? Not me. See my 3 September 2009 post: Obama is something, he can't stop lying for a second, all while believing he's got over a 200 IQ like Albert Einstein. What does "quality of care" mean? Is it like "quality" schools? Is "wasteful medical spending" any treatment for a white woman over 80? What is a "similar" patient? Every year 10% of doctors will be at or above the 90th percentile, by definition. The SHHS will give these doctors less money. To escape next year's list, the doctors on year one's list reduce treatments. In year 2 a new group of doctors is at the 90th percentile or above. The new group reduces treatments. Every year treatments decrease because of what I call a "ratchet effect". Obama, spare us this nonsense. Just feed the old white women hemlock. "Aimed at reducing waste", i.e., old white women.

1 comment:

Anonymous said...

I don't know IA...

I'm almost always in agreement with you. But this approach makes sense to me.

We must ration care.

This proposal puts the physician in the center of the web of decisions regarding allocation. And disincents upward gaming of the reimbursement system.

You're quite cheery IA today ... Ad hominem attacks aside...