Health reform barely touches these fundamental failings that are driving so much of our health insurance premium increases and our medical over-spending generally.
If a fraction of the public ire about government misspending were redirected at our spendthrift medical profession, we might reclaim some of the hundreds of billions a year we waste on “medical misadventures” – the quaint term used by doctors for medical mistakes that cost us plenty.
We might also rein in the rampant medical greed that pads the bills of patients and the incomes of too many of our doctors.
CORRUPTION Isn’t CAPITALISM
There are those misguided souls who defend all this as capitalism at work.
But they’re as off-base as the naive health reformers who believe doctors and hospitals will reverse their current practices and start coordinating our medical care more efficiently and effectively because of superficial changes to their payment schemes.
The folly of this assumption is addressed in Our Healthcare Sucks, which notes that doctors and hospitals always find ways to game health insurance payment systems. The experience to date with global payment systems eventually envisioned under health reform confirms the realism of this view.
Many doctors currently “game” these alternative payment formulas by simply ordering more tests to increase the “risk profile” of their patient population. They get paid under these health insurance arrangements for their patient population, not their individual patients’ care requirements.
As a result, many learn to inflate or pad their patients’ risk profiles with unnecessary tests rather than pad their patients medical bills directly with unnecessary tests.
New Ways to Game the System
Under the current fee-for-service payment system, you’re likely to be billed directly for unneeded tests and procedures. Under global payment formulas slated to replace fee-for-service payments, you’re likely to be billed indirectly through higher health insurance premiums driven, in part, by an inflated patient risk profile of your patient panel or group.
The higher the risk profile of the patient panel, the higher the payments doctors receive for that patient panel.
The incentive to order unneeded tests is more indirect, but it’s no less real.
The fact that many doctors choose to exploit these unintended incentives reflects the deteriorating ethics underlying much of medical practice in America.
As long as insurers, regulators, and employers tolerate these unethical practices, they’ll persist no matter what health insurance payment formulas are applied. Unethical people always seek and find ways to game the system, and doctors are no different. Our current experience bears this out in spades.
The difference with doctors is their unethical behaviors cost us not just in dollars and cents, but in human lives lost due to their income-padding medical practices.
We’ve invented a term for this in Our Healthcare Sucks – “predatory medicine”.
It’s predatory medicine that’s driving much of our excess medical spending – and our excess medical mistakes.
And it’s predatory medicine that’s bankrupting America – and an increasing number of its families and small businesses.
Isn’t it time we demanded that this change?
Tell us what you think below.
Have you experienced “predatory medicine” in your own care or that of a family member?