Monday, December 17, 2012

Notable and Quotable: Mark Steyne, “The Doctor Won’t See You Now: American Health Care Is In a Bureaucratic Death Grip,” Nation Review Online, December 14, 2012
December 17, 2012
No foreigner can even understand the American ‘health care’ debate, which seems to any tourist casually surfing the news channels to involve everything but health care. Since the Second World War, government medical systems have taken hold in almost every developed nation, but only in America does the introduction of governmentalized health care impact small-business hiring practices and religious liberty, and require 16,500 new IRS agents and federal bonuses for contributing to a national database of seat-belt wearers. Thus, Big Government American-style: Byzantine, legalistic, whimsical, coercive, heavy on the paperwork, and lacking the one consolation of statism — the great clarifying simplicity of universal mediocrity.”

“As I wrote a couple weeks ago, Obamacare governmentalizes one-sixth of the U.S. economy — or the equivalent of the entire French economy. No one has ever attempted that before, not even the French. In parts of rural America it will quickly achieve a Platonic perfection: There will be untold legions of regulators, administrators, and IRS collection agents, but not a doctor or nurse in sight.”

The  idea that data documentation  of every  medical encounter solves everything obsesses Obamacare reformers..  
With data, you can prove what works, you can improve outcomes,  you can separate good doctors from bad doctors,  you can decide what to pay for,  you can create online health exchanges telling patients what to shop for,   you can create unbelievable efficiencies,  you can get a handle on everything that transpires in our complicated health system, and above all, somehow you can magically cut costs.

But alas, a host of unexpected consequences  keep cropping up.  Data complicates and  distracts from the patient-doctor relationship.  It takes money and  clerks to enter the data.   It reduces doctor time spent with patients.   It’s expensive for doctors to install electronic health records. It alienates doctors and contributes to the doctor shortage.  It forces doctors into hospital employment, where doctor costs are higher.   It creates security problems: who has access to the data and what are the analysts  going to do with it.  It threatens doctor-patient confidentiality. It shift personal attention from the patient to impersonal data  collection. It transmogrifies formerly simple transacctions into complex encounters that  neither the patient or doctor enjoy.   In short,  documentation  interferes with doctoring.

What is the basic problem?  As the late Peter Drucker commented , “Government is a poor manager. It is , of necessity concerned with procedure, for it is also, of necessity, large and cumbersome.  It must administer  public funds and must account for every penny. It has no choice but to become ‘bureaucratic.’ Every government, is , be definition, a ‘government of  forms.’ This means high costs, for ‘control ’ of the last 10 percent  of phenomena always cost more than control of the first 90 percent.”
Goverment bureaucratic oversight always costs more not less.

Tweet:  The obsession of health care government  bureaucrats and managers  often interferes with and distracts from the doctor-patient relationship.

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