Tuesday, April 24, 2012

Corruption in Medicine


Somehow I missed your  post in praise of fee for service medicine. While I believe there's lots wrong with such a system, I know better than to base my arguments on the basis of either of justice or fairness, at least in the context of our ongoing conversation. If I understand it at all by now, the libertarian world view believes that a free market in health care would best accomplish the essential task of providing the most care to the most people at the best price. I suppose as well, the libertarian may argue  that the failure of the present system to accomplish any of those goals is a reflection of how far it has strayed from free market principles. The libertarian might argue further that the absence of any extant example of free market based health care only strengthens the idea that such an approach would work if we would only try it.

So how about this argument. Fee for service medicine, which rewards health care providers only for doing things to patients, is inherently corrupting. I have seen this in my own professional life with colleagues in practice and with referral sources. I remember vividly the complaint I received from a patient (a lawyer, what else) when I refused to order a routine stress test for him after an angioplasty. His previous doctor ordered one for him twice a year, he reported proudly, so my decision to avoid an unnecessary, costly, and potentially hazardous test must be due to my efforts to limit care. This was a man who was receiving biannual doses of unnecessary radiation at cost of about 5000 bucks a pop, a practice that contradicts every guideline in this area. Why? Because his cardiologist leased a nuclear camera, and had to keep it humming to pay the bills, and line his pockets.

And please do not tell me that in the free market health care system you long for, "consumers" will make rational informed choices. We are not talking about consumers. We are talking about patients. People who are sick, in pain, and scared. Folks in that position generally do whatever their doctors tell them to do.

BTW I'll take your Left Wing Limbaugh as a complement. If only I were that effective. Guess I'll just have to work harder at sharpening my ad hominem attacks.


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