Wednesday, February 29, 2012

Worth Reading - Article by Dr. Jay Fleitman - on The Shift in Health Care Delivery -

Usually one finds this blog commenting on an particular article, however this one article by Dr. Jay Fleitman is not only of great import, but aslo informative. To that end, it is shared here in the interest of the public.

From the Hampshire Gazette: "Jay Fleitman: Liberty bows in health care shift
By JAY FLEITMAN"

Tuesday, February 7, 2012

NORTHAMPTON - As chairman of the board of a local health care corporation, I recently prepared for our annual meeting, which was attended by over 100 physicians and representatives of the hospital administration and board of trustees. I discussed new and coming health care vehicles we have with the major insurance companies of Massachusetts.

These will fundamentally change the way health care is delivered. They carry acronyms like AQC (alternative quality contract) and ACO (accountable care organizations). These are known as risk sharing arrangements, which means that the providers of your medical care, hospitals and physicians, are at risk for the cost of the health care services they deliver to their patients. The less they spend on delivering those services, the more they are awarded in bonuses.

Yes, there are incentives built in for delivering quality care, but the real driver in these plans, both through private insurers and government, is to reduce the money spent on medical care. Legislation coming on Beacon Hill will accelerate this process already in place through Medicare and large Massachusetts insurers.

The holy grail and ultimate endpoint of this process is population-based care. This model has associations of physicians and hospitals being paid a lump sum to manage care for an entire defined population of consumers.

This is the future envisioned for American health care. The health care dollar, it is argued, will be more efficiently managed by consortiums of experts whose job it is to define what choices are acceptable.

One thing is conspicuously missing from these discussions. This is America, land of the free, a nation predicated on the liberty of the individual. The discretion of the individual citizen and family to control their own destiny is never part of these deliberations. The American citizen will be progressively stripped by experts and payers of their freedom of choice in personal health care decisions.

Americans would never tolerate this interference in our choices of food. We chafe at the government forcing our choice of light bulbs. Yet, for health care we are giving away our freedom to entities with no knowledge of the intimate details of our lives.

The money being managed by these systems is the private citizen's money. Whether it is your taxpayer dollar being spent in a government program or the insurance premium being paid by your employer as part of your reimbursement package, it is the individual's money being given over by proxy.

The "individual mandate" requires the citizen to buy insurance or pay a tax surcharge. By having everyone in the pool, the premiums on average are cheaper for everyone. What's next? Tax anyone over the age 50 who doesn't have a colonoscopy because they may ultimately cost the system more money if they develop colon cancer? This is not so farfetched. We tax cigarettes with the rationale that smokers cost society more in health care costs. The Massachusetts governor recently applied the same notion to raising taxes on candy and soda.

The Republican presidential candidates speak of fundamentally restructuring the health care system, and they are right. The health care dollar must be in the hands of the American citizen, not distributed in larger and more remote schemes by insurers and bureaucrats who are distant from individual choice.

This is not hard to craft. Indiana offers state employees the option of having catastrophic insurance that protects them after $8,000 in medical costs, and a health care savings account that covers the first $5,000 of the up-front cost. The employees keep the unspent money at the end of the year. Eighty percent of employees chose that plan, and their freedom in administering their own health care costs them 35 percent less than usual insurance plans. If someone understands the benefits of a medical service and decides not to spend their money on it, that is their choice to make. They may have better use of that money - a child in college or a sick parent.

We can open up markets across state lines, giving consumers far more choice in products.

I manage my medical practice by these politics. I believe that it is my duty to the fellow citizens who seek my care to respect their autonomy. I inform them of their choices and options, so they are able to exert control over their lives.

I am tempted to say that if Americans continue to cede their freedoms, the nation deserves to lose them.

Unfortunately, we are the protector of these freedoms for generations to follow, and so we squander their heritage as well.


As a physician living in Massachusetts under mandated Universal Health Care, as well as the Federal version, one can get a better grasp on the problems faced by physicians in their health care delivery and the solutions they offer, based on expertise not owned by a bureaucrat. Many thanks to Dr. Fleitman for sharing this most important article.

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