What makes Michigan so special?
I want my heart stent and I want it NOW. Better make it two. I plan to eat a lot of bacon and ice cream next week. Bacon ice cream.
It’s because of the ol’ fee-for-service model of service delivery. Paying docs for what they do to you instead of how easily and quickly they patch you up and send you back on your marathon-running (or -watching) way.
But here’s where I get a little peeved: Obamacare actually moves to stop this. It begins to change the existing health care industry by forcing agencies to re-haul their billing and incentive systems to both lower costs and improve outcomes.
It’s the most moderate, measured reform around. It’s like buying your grandmother a slightly better food processor than the one she already had, to let her make the same foods a little faster with a little less frustration. Rather than destroying her kitchen and ordering her to go to a soup kitchen till she dies, or whatever the European-socialist-takeover equivalent would be in this analogy.
The health-reform law does take some steps to address these unnecessary procedures, by creating new payment models where providers would essentially lose money by performing procedures they don’t need to. That’s the whole idea behind the health law’s Accountable Care Organizations, where doctors band together and take a lump-sum for covering a set number of patients. If they can deliver care for less — while hitting certain quality metrics — they pocket what’s leftover. Doctors that perform unnecessary care, and go over that set amount, will find themselves in the red.
No one would expect the entire health care delivery system to voluntarily change overnight into a magical outcomes-based-incentive structure. We need some moderate legislation to dangle the federal money carrot in front of their scanners.
Now, we expect to be able to tell teachers Hey! Starting next month, you’re going to be paid on student outcomes that have ALMOST NOTHING TO DO WITH YOUR TALENTS AND SKILLS, and you’re going to lose pay for reasons that have very little to do with anything you did in the classroom, because it’s politically and culturally popular to blame you for the effects of economic inequality.
But no one would think for a second to tell a bunch of doctors, Hey! Starting in 2014, we’ll start paying you for patient outcomes that actually do, in fact, have almost everything to do with your talent and skill.
Imagine if we all got paid fee-for-service! Let’s abolish salaries completely and pay people according to how much equipment they use, how many drafts they write, how many widgets got widgeted.
Or how many pieces of helpful, meaningful legislation you managed to pass.