July 11th, 2008
A health policy turning point?
Paul Krugman of The New York Times thinks this week’s Medicare vote (which we discussed earlier) was a major turning point.
Whether it was or not depends heavily on the doctors’ lobby, the AMA.
(The cartoon to the right was by James Gillray, a British political cartoonist who 200 years ago was very much a name to conjure with.)
For the AMA this week’s vote was a no-brainer. It was trying to roll-back cuts in reimbursements to its members. You can’t get lost sticking up for the members.
But the larger question, for many doctors, remains unsettled. And for many it’s one of those Scylla and Charybdis deals. (That’s what Gillray was drawing here, referencing the political questions of his time.)
What most doctors want, more than anything else, is autonomy. They want to run their own professional lives with the greatest possible freedom.
What they face now is, on the one hand, a future determined by insurance companies. The carriers decide upon reimbursement levels, on billing, and on who shall be treated, how.
Many doctors chafe under this. That’s why we have this rush toward concierge medicine. If choices on who not to treat are to be made, doctors want to make them, and not have them forced upon them.
A universal health system, and for seniors Medicare is pretty universal, offers a different set of problems, one illustrated by this week’s vote. You cover everyone, but government decides how you will be paid, and what will be considered basic care.
Both doctors and insurers have long chafed against these cost restrictions, and the Medicare Advantage idea was seen as a solution. By placing care under insurers, and offering additional funds, hard choices could be put off for a time.
A very short time, it turned out. Given a choice between the financial advantages of the insurance-backed Medicare Advantage and the government-backed Medicare, doctors went with Medicare.
Whether they continue to do so depends an awful lot on whether, in next year’s health policy debates, doctors see more autonomy on the insurance side or the government side.
That’s what they will be looking for. That’s the clear water beyond the rocks and whirlpool. Right now, to most doctors, that clear water seems very far away.
Dana Blankenhorn has been a business journalist since 1978, and has covered technology since 1982. He launched the Interactive Age Daily, the first daily coverage of the Internet to launch with a magazine, in September 1994. See his full profile and disclosure of his industry affiliations.
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| 07/11/08
