Those who would give up essential liberty to purchase a little temporary safety deserve neither liberty nor safety. Ben Franklin
Medicare chief Don Berwick published an article in last weeks Wall Street Journal (The Right Way to Reform Medicare-4/29/11) that reminded me of one of my favorite books from high school. George Orwell’s 1984.
Orwell’s “doublethink” and Berwick both sound wonderful…. so long as you don’t look too closely. Berwick’s observervation that “improving quality while reducing costs is a strategy that’s had success in many other fields…like computers, TVs and phones” sounds great….until you realize that in all of those fields success and progress came from freedom to satisfy the consumer…or failure as people bought the competitors product.
Currently in Medicare, if a patient chooses to pay his own money to a physician with a fee more than the amount Medicare allows for a covered service, the physician is legally prohibited from accepting the payment. He is allowed to care for patient…so long as the patient does not pay the physician his fee. So I am somewhat skeptical when Berwick promises “Seniors will not have their choice of physician or hospital limited at all” because providers “will be held to a strict set of quality standards to ensure that they aren’t lowering costs by cutting necessary care”.
Who is deciding standards, and what is necessary? As a doctor of chiropractic, the thousands of people I’ve helped over the past 30 years might disagree with the many orthopedic surgeons who believe spinal manipulation and postural therapy is not necessary. Thankfully, my patients had freedom of choice. Then.
I find it hard to believe the people who designed the efficiencies of the USPS to carry a letter when they tell me they are going redesign healthcare and “reduce costs by improving care with a…set of rules for doctors, hospitals, and other providers who want to work together”” by “reducing duplicate tests and procedures that hassle patients”. Rules about how clinicians MUST choose to work together to avoid hassling people…or else not be allowed to care for people? Orwell anyone?
Coming Soon: Comments on why building relationships and a Patient Choice practice model towards prospering in the shifting terrain of the second decade of 21st century healthcare.
Steven Weiniger DC DrWeiniger at BodyZone.com
