Thursday, January 9, 2014

Health Law Rests on Assumptions 

Most of our assumptions have outlived their uselessness.

Marshall McLuhan (1911-1980), author of The Media is the Massage

We are all, in one way or another, creatures of ours assumptions.   We assume our assumptions are superior to the assumptions of others.  We rarely challenge our assumptions until they clash with reality, go south, or outlive their usefulness.

Here is a sampling of health law assumptions.

·         That health care is a national issue that must be administered from Washington, D.C. for both government and non-government care.

·         That it is possible to standardize health plans with a uniform menu of benefits covering all eventualities for all people.

·         That health care, as delivered by the Centers of Medicare and Medicaid,  is more efficient than that  delivered by private doctors and hospitals.

·         That specialists, especially high income specialists like cardiologists, orthopedists, proceduralists  of every ilk,  are in for the money, and their fees therefore must be reduced.

·         That fee-for-medicine is a formula for greed and overuse.

·         That high malpractice premiums, frivolous law suits, and actions to prevent these suits, have little or nothing to do with the overall cost of care.

·         That  it is  primarily  the fault of hospitals and doctors that patients are re-admitted to the hospital because of  faulty discharge planning.

·          That doctors and hospital can control the behavior of  patients once they return home pr to their place of work.
·          That government can control poverty,  now at all  time high, through enlightened social engineering.

·         That market-driven health care,  especially when driven by conservative thought,  is intrinsically evil and self-serving, as opposed to compassionate government programs. 

·         That government policies are free of folly and fallacious assumptions.

·          That poor or inefficient health care is responsible for most poor health care outcomes,  whereas in reality health care accounts for only about 10% of health outcomes with  rest due to inadequate family, social, or economic conditions.

·         That the haves got where they are be taking advantage of the have-nots, and income inequality is the root of all evil.

·         That doctors in large groups or expanded networks offer superior care to individual physicians or physicians in small groups.

·         That government care created by experts, managers, or elistists is inherently superior and produces superior results than that delivered by individual physician acting in concert with patients.

·         That computer systems,  using mass metadata information, artificial intelligence, or learning algorithms, will produce better outcomes.

·         That it is possible to judge  and control the performance and interaction of patients and physicians using government guidelines and protocols and computer algorithms.

·         That patients, using their own money in health savings accounts,  do not have the information, judgment,  or self-responsibility, to make wise clinical decisions about their own care, and are unwitting vulnerable victims of avaricious clinicians.

·         That health consumers and patients are not sensitive to price or outcomes and do not how to judge or separate good care from bad care.

Every health reform, however necessary, rests on philosophical assumptions, which if carried to excess, may need reforming and questioning if they fail to produce the desired results or result in unintended consequences. 

Tweet:    The health law rests on assumptions for reform that may not be valid and may produce undesirable results.

1 comment:

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