Romneycare and the End of Fee for Service Medicine

Bill

An interesting piece in this week's New England Journal of Medicine on the efforts of the Massachusetts medical community to address the issue of cost. Romneycare has done an excellent job of insuring the access issue, as under its aegis more that 98% of the citizens of the Bay State now enjoy some form of health insurance. But the state now finds itself running an unsustainable deficit in support of the policies the law promulgated (sound familiar?) and is beginning to explore the steps necessary to close the gap between what's coming in and what's going out.

The preferred answer is likely to be grounded in the formation of accountable care organizations or ACOs, which we have discussed previously. Once again, this is an innovation transferred directly from Romneycare to Obamacare, and it is the sort of collectivism that I imagine most conservatives simply hate. ACOs among among other things are an extraordinary effective vehicle for  rationing by another name. They also foretell the end of fee-for-service medicine. No longer will docs get rewarded for doing more, but for doing what they can with the resources determined by the number of covered lives the ACO controls.

I greet these developments with ambivalence. On the one hand, I cannot justify the enormous sums paid to physicians during what will surely be seen as a golden age (medically and financially) for medicine in the post WWII era. On the other, I have no doubt that the generous salary I've earned as an academic cardiologist is directly related to the even more lavish earnings of my colleagues in private practice. A third of a heckuva lot is still a lot.

Eli