Tuesday, April 24, 2012

One More Time. What's Wrong with Fee for Service?


Your "Corruption in Medicine," takes a bit of license with what I said, and of course I wasn't precisely clear on my point. So I'll try it again.

The main point I was trying to make was a one-size-fits-all medicine doesn't quite make sense to me. As a couple of examples I pointed out face lifts and Lasik seem to do quite well with fee for service. The presumption was if I can easily come up with two examples, there are probably more.

You are correct, when a person has an exigent need for medical services, price shopping probably isn't the best way to go about buying it. But I didn't make that argument, and I'm not making it now. In fact, it supports my argument that different circumstances call for different ways to serve the need.

I do disagree with your assertion that patients "sick, in pain, and scared.. generally do whatever their doctors tell them to do." I have an even higher authority that disagrees with that statement: You. In the previous paragraph you bemoan the patient who didn't listen to you about extra testing. Someone, shall we call him a consumer, just for grins, who listens to multiple opinions and chooses what he thinks best. It seems to me, until doctors have a unanimity of opinion, or are prevented from having a different opinion by law, there will always be consumers seeking out the second opinion. I thought it was recommended patients when purchasing medical services get a second opinion. But if patients are incapable of making a decision, why on earth would we counsel them to get a second opinion? Are you sure you want to stand by the statement that patients "generally do whatever their doctors tell them to do?"

And that is germane to the fee for service argument. The assumption made for preventing fee for service is  consumers are incapable of choosing the appropriate care. But from your example it looks to me like the group incapable of choosing the appropriate care is the medical community. 

So we come back to the same question we've been circling around. If the medical community makes bad decisions, why do you think an unelected medical group, the IPAB, in thrall to Congress and the President will do better than me at making decisions for my care?


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