“Paying doctors for results rather than procedures …”

Just exactly what on earth does that mean?

From The Washington Post, whose article describes President Obama’s new plan to lower our Federal budget deficit through tax increases and (snort) “spending cuts”:

Administration officials and outside experts say the most likely path to revamping the health system is to begin with Medicare, the federal program for retirees and people with disabilities, and Medicaid, which serves the poor. Together, the two programs cover about 100 million people at a cost of $561 billion in 2007. Making policy changes in those programs — such as rewarding physicians who computerize their medical records or paying doctors for results rather than procedures–could improve care while generating long-term savings, expert say. It also could prod private insurers to follow suit.

I don’t really have the time or the desire right now to analyze the whole piece. Anyway, an analysis pretty much writes itself, if you simply ask a few good questions:

  • How are we going to cut the cost of Iraq and Afghanistan if we just committed another 17,000 troops to Afghanistan?
  • What else besides the Defense budget (one of the few large mandatory items in the Federal budget, in case you didn’t know) will be cut? And by how much?
  • Just exactly whose tax rates will go up in 2011?
  • Is raising taxes, especially on businesses, a good idea during a recession? Will tax hikes raise more money than tax cuts and the economic growth that always follows them?
  • Just exactly how much will the proposed expansions of Medicare and Medicaid (and SCHIP) cost, and how can we realistically pay for those increases?

And so on.

In a nutshell, here is the plan:

We’ll drastically increase Federal spending through the Stimulus Plan and a continual series of “reforms” that we will enact during the next few months. We’ll offset those spending increases with some token budget cuts and a massive scale-back of our military, and major tax rate hikes. Then we’ll cross our fingers and hope all the numbers work out.

President Bush lowered tax rates for every single taxpayer, so it is possible that every single tax payer will have their taxes raised. Remember the Obama campaign’s waffling about the definition of “rich”? Everyone is a potential target. Enjoy that extra $13 a week while you still can.

But that’s not what really worries me. I want to know how my health care is going to be impacted by all of these “reforms,” especially the ones designed to drastically cut health care spending.

How do you pay a doctor for “results,” without seriously compromising health care for the aged and terminally ill? If a doctor prescribes chemotherapy for a cancer patient and his cancer does not respond, does the government say, “Sorry, you didn’t get the desired results, so you don’t get paid”? Does a doctor tell the family of a cerebral aneurysm victim, “Well, we could treat him aggressively with drugs and emergency surgery, but right now his chances for survival are less than 50%, so the government probably won’t authorize payment”? If that victim survives, is the family further told, “It looks like he will be severely mentally impaired and will require full time skilled nursing care. We’ve been advised to withhold food and water because he will never recover, he could linger indefinitely, and the cost of caring for him will be too great”?

This is probably the most dangerous idea put forth by the government during my lifetime. If you don’t regularly pay attention to government policy debates, then you had better start paying attention now.

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