This issue has to be handled carefully by reform proponents. Otherwise leftist pols, in tacit collaboration with tech lobbyists who want to be paid to create an automated version of the current system, with reduced costs based on fewer workers and worse (rationed) service, may frame the issue as NHS-style single-payer vs. greedy doctors. Therefore it’s important to argue that the right kinds of reforms might greatly improve the quality of medical care AND the patient’s experience, as well as reduce costs. Mead doesn’t quite make this case.
Currently one sees increased reliance (in the USA) on nurses and physician’s assistants to do things that physicians formerly did. This makes sense to some extent but there is a limit to the amount of skilled work that can be shifted away from physicians without degrading quality of care. The Obama model is to cut costs by overworking a smaller number of physicians while shifting as much work as possible to less-well-paid workers, making patients wait longer, reducing quality of care overall and expecting people to put up with it. The better alternative would lower costs and improve care by using technology to increase productivity.
The Obama model is hostile to the high-tech alternative because 1) the Obama people don’t have a clue about either economics or medicine and 2) high-tech reforms would contribute to decentralization and individual control of medicine, and Obamaism rejects decentralization and individual control on principle.
3 thoughts on ““Healthcare 2.0””
“Physician extenders” as nurse practitioners and PAs are often called, can do a lot of routine work but need readily available supervision. Not necessarily to “manage “what they do as much as provide immediate consultation, like “Is this lump important or not ?” My ex-wife has a masters degree and worked as an NP for a local GP. He was usually too busy to stop what he was doing and respond to her requests so she used to call me. We had been divorced for years but were on good terms. With that help, I’m sure she did a good job. I later learned that she was the “family doctor” for my daughter-in-law’s family. They loved her.
The problem is that it is tempting to be independent, especially when it is inconvenient to get advice. Obamacare will contain a strong incentive (like criminal prosecution, for example) for doctors to follow guidelines that are not based on science but on “consensus.” The consensus is coming from a committee of academics (They are already jockeying for assignment) who know nothing of primary care and who have always practiced one level removed from the patient. This is a recipe for trouble.
They are promising primary care docs that they will respect them and pay them well. EVery time the government decides to cut high tech medicine or surgery. they set the primary care docs against the target group. LIke Lucy with the football, they always seem to fall for it. The last time was the “Resource Based Relative Value Scale” which cut surgeons’ incomes, supposedly to increase payment for primary care. It didn’t happen. That’s when I quit the AMA.
It has been fairly conclusively shown that the various Health Providers skim vast amounts of money for sometimes ridiculous charges for many things and procedures. This is why your health system is so much more expensive than any of the other medical plans that exist in the first world.
Your doctors and nurses make a bit more than many other countries’ medical professionals but it is no where near to creating the high cost of health your providers require.
I’m pretty sure a serious criminal investigation would reveal lots of reasons for the costs of service. It will never happen.
PenGun is applying for a job as medical policeman. There is no limit to what you can learn on a garbage truck.
I don’t even think you know the difference between “retail” and “wholesale” pricing in the US medical market, or why it exists.
That’s no criticism as many Americans don’t know either.
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