Tuesday, June 3, 2014

Government Versus Private Practice: An Uneven Contest

No Contest:The Case Against Competition: Why We Lose in Our Race to Win

Alfie Kohn, title and subtitles of his 1986 book , published by Houghton Mifflin Company, 1986

Yesterday two things happened:

One,  Donald Copeland, a family physician in Cornelius, North Carolina, just outside Charlotte, called to say it was no contest between the forces of government and family physicians who wanted to opt out of Medicare, Medicaid, and other 3rd party arrangements to enter direct pay practices.   Government has the power, the health law, and most of the media on their side. Doctors were insufficiently organized,  possessed little capital, and possessed insufficient marketing power to plead their cause.

Two,   Jane Orient, MD,  internist and executive director of the American Association of Physicians and Surgeons,  sent me  a fund-raising  letter protesting the burdens imposed by “Maintenance of Certification” and “Maintenance of Licensure” schemes that further burden private practitioners already drowning in regulations and their attendant expenses.   

She says, “Surely you agree that your time is better spent seeing patients than being demeaned  by some unknown bureaucrat who take your time and money and give you exams that have no connection with the case you offer.” 

She goes on.”Nearly every government and corporate entity is trying to interfere with the practice of medicine and drive out independent physicians.” 

She adds,” Private doctors are the scapegoats.  Medical boards are harassing doctors. Insurance companies are refusing to pay for 0ut-of-network physicians.  Sham peer review at hospitals is driving out good physicians.”

It is an uneven, perhaps even no contest.  Centralized  government thinks it can impose its will on physicians.  Private physicians have no centralized organization pleading their cause.   The AMA is of no help.   It has backed ObamaCare and seems more preoccupied with collecting its revenues from its lucrative coding system rather defending private practice.

The government’s case for the future of private practices sound simply enough- collaborate rather than compete.  Competition is destructive.  Collaboration and cooperation are constructive. Or so it says.

You physicians.  Gather together in collaborative teams.  On those teams, place other health professionals of every ilk. Lead those teams. Have frequent meetings with them.  Team with hospitals.   Think of your patients not so much in terms of their individual health  but as participants in  “population health.”  

 Your performance will be judged by computer analysis of the outcomes of your population panel.   To make this population concept work,   you will each need to scrupulous code every detail of your patient into something called the ICD-10 coding system.   You will need to carry a computer with you everywhere you go.   You may need a “scribe” to help you enter the data.   You will definitely require a comprehensive electronic health record system, to be installed and maintained at your expense. Above all, you will have to spend time away from your patients, dealing with the technocratic details.

Do not believe those myths perpetrated by advocates of market-driven system: that competition  is part of human nature; that it motivates to do our best; that it raises quality and lowers costs, that it distributes health care services in a more timely manner;  that it gives patients more choice and power.

You know better.   Look at those “free” single-payer systems in other countries.   

Think of how these systems bespeak and reek of government compassion.   Ignore that these systems are breaking the budget banks of these countries.  Forget that these countries are scrambling to set up alternative market systems.   Do not look at the current “death while waiting” VA system in the U.S. and the lengthening waiting lists of those other countries. 
These are aberrations.  These systems will get it right.  eventually, maybe not in your lifetime, but later rather than sooner. 

 And by all means,  do not consider the fact that private physicians, in sufficient numbers, are the key to any successful health system.  And ask yourself this question: What good is universal single payer care without physicians to deliver that care.

Tweet:   Government is competing with private physicians to deliver health care.  At this stage, it is no contest.  Government has the power, podium, the health law, and money  on its side.

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