Saturday, December 19, 2009

The Government's Two Five Year Plans

Not so long ago, I was speaking to John McDaniel, President and CEO of Peak Performance Physicians, a physician management firm in New Orleans.

John remarked , tongue-in-check but with malice of forethought,

“Why don’t we just separate hospitals and doctors into government hospitals and government doctors, and private hospitals and private doctors. Doctors who don’t want to be government doctors can simply go into private practice. People can have their choice which hospitals and which doctors to choose.”

John knows this will never happen, but he was expressing a common unarticulated fear among conservatives underlying the current health reform debate, viz, we will get what we wish for, universal coverage dictated, controlled, and regulated by central government with the inherent uniformity and mediocrity of government-run systems but without private choice.

Good Enough for Government Work

We have an expression in America, “It’s good enough for government work.” This means you do your work, you do it competently, you do it unenthusiastically, you do according to government standards, but you do no more.

After all, the work is impersonal, does not demand excellence, and you’re doing it to get through the day. It is not for you, but for the Big Guy.

This is overstated, of course. Government workers in general like their work, they are competent, they are paid well ($75,000 on average, and they are in a growing sector of the economy.

As a government employee, your job is secure, and you are not competing with the private sector. You are simply doing your job as best you know how, according to government plans.

Speaking of government plans, the current House and Senate Reform bills are basically split into two five years plans – 2010 to 2015 and 2015 to 2020.

2010 to 2015 Plan

The 2010 to 2015 plan will be a tax and implementation plan. The idea is; tax now, save later. It will tax Cadillac plans, the wealthy, the insured, the young, drug companies, and device manufacturers; expand Medicaid in all the states; impose federal mandates on individuals and employers backed by the IRS, define the precise benefits of all health plans; give citizens some sort of public option; reward doctors and hospitals who adopt EMR surveillance systems; establish comparative effective research protocols to decide what treatments to pay for; cut out payments for ineffective care or care to those with a limited quality of life; and establish scores of new bureaucracies to make sure everything works according to plan.

There will be no benefits offered during this phase. Government will be too busy implementing and doing demonstration projects. It will be the “money-out” or spending phase, as the government invests in its vision of the future.

2015 to 2020 Plan

That leads us to the 2015 to 2020 plan. That is where the “savings” will kick in.

By “savings” I mean the theoretical returns on investment from EMRs, which will supposedly wipe out duplication and ensure hospitals, doctors, and patients are making the “right” decisions, i.e. those for which they will be paid; the coordinated, comprehensive, integrated primary-based care across the entire care spectrum; and the widespread preventive care programs designed to nip chronic disease development in the bud.

This is the phase in which the government will cover everyone and protect us all against bankruptcies and excessive and unnecessary treatments. During this phase, if current projections hold, Medicare and Medicaid will be in bankruptcy, and it will be necessary to tax all Americans to make up for federal deficits, which will steadily grow under new entitlement programs, as they always have.

But not to worry, your government will be protecting you, and your care, though it may be mediocre, will be uniform, systematic, and provided by those who meet government pay-grade standards. Government care will be your only choice, but that’s alright. If it’s good enough for government, it’s good enough for you.

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