Shawn Whatley is past-president of the Ontario Medical Association. He has worked in emergency medicine, as a coroner, in a vein clinic, and as a surgical assistant. He also held a leadership role at a large suburban hospital. He now practises family medicine in rural Ontario. Visit his blog at shawnwhatley.com.in rural Ontario. Visit his blog at shawnwhatley.com.
Hospitals lose money for seeing more patients; doctors earn more for seeing more patients
Unlimited sick days for some nurses
March madness: hospitals spend like crazy before year-end or lose funding for next year
Pharmacists paid more for same service than MDs (e.g. flu shot)
Black market in radiology and lab licenses
NPs and midwives earn more per patient than MDs
Labs have fixed budgets: more tests means less profit per test
Single payer healthcare also raises other, more challenging problems:
Those who know cannot speak. The system suppresses dissent. People cannot speak up, because they have nowhere else to work. Professionals working in hospitals or academia must stay quiet. Single-payer systems give tremendous power to administrators who run the monopoly. It enriches and expands government. Price controls appear to limit costs, but profits are found in other ways. For example, price controls force doctors to shorten visits, unbundle care, up-code, or stop providing a service. Centrally planned single-payer systems function on Hayek’s Fatal Conceit, the assumption that planning is possible:
The curious task of economics is to demonstrate to men how little they really know about what they imagine they can design.
Local knowledge is impossible to capture or to use in managing the system. Single-payer systems incentivize collusion with government to exclude competition. It creates a psychological change in Canadians. Whereas choice empowers patients, single-payer fosters dependency on the system. It creates increased demand for fixed price services but decreased availability of those services. Single-payer assumes that bigger is always better. But bigger often becomes too big to manage. A CEO of A.T.&T. once said, “A.T.&T. is so big that, if you gave it a kick in the behind today, it would be two years before the head said ‘ouch.’”
Hats off to John C. Goodman again! His work in leading the effort for market-based healthcare reform over the past 4 decades, and highlighting the government’s role in the dysfunctional mess we labor in, is second to none.
This Forbes article lays out a most concise and accurate rendering of what healthcare has become and why…and what to do about it.
If you’re tired of the hearing healthcare pundits wax feverishly about their favorite villains and how more regulations are the answer; or if you’re just a novice starting to explore the Healthcare conundrum, Dr. Goodman’s work is required reading. I recommend starting here and then circling back to some of his earlier work. The book “PRICELESS” is a recommended next step!
Honest price-transparent markets allow value propositions to surface and to be discovered.
Contrary to the outcries of many academics, intellectuals and utopian collectivist, free markets don’t create wide-spread abuses or anarchy in peaceful law-abiding Societies. The anti-market narrative attempts to impune the term “free” in free-markets by equating it with lawlessness and all manner of fraudulent activity; rather than acknowledging that “free” means maximal freedom from unnecessary economic distortions. One only has to look at the litany of government scandals (VA comes to mind) to conclude that vice is not intrinsic to, or a consequence of, the exercise of free commerce, but rather a malevolent side of human behavior.
Markets not only provide a functional platform for innovation and creative destruction, but can help suppress waste, fraud and abuse by aligning incentives such that mutually beneficial outcomes are the rule, not the exception. Markets that are willing to operate in the light of transparency are in stark contrast to systems where avarice and other human foibles seek cover behind complex non-transparent systems or within unaccountable bureaucratic hierarchies.
In healthcare, the behemoth we call the 3rd party payment apparatus (and regulatory morass that supports it) often creates an environment which, unlike a more transparent market-oriented approach, allows bad behavior to go unchecked longer.
To the extent that we view market transparency, and all the downstream benefits that result from full disclosure, as the best chance of uncovering AND discouraging human vice, then many of the bad actors and bad behavior will be found out more readily. This approach benefits all stakeholders in healthcare.
Also, transparent pricing & markets naturally lends to transparency in quality measures, and thus better value propositions.
We should embrace changes which incorporate as many intrinsic disincentives to bad behavior as possible, as well as maximize the correct incentives – which helps healthy & sustainable endeavors to thrive.
Hundreds of NHS managers have amassed million-pound pension pots while presiding over the worst financial crisis in the history of the health service… As patients face crippling delays for treatment, A&E closures and overcrowded wards, bureaucrats have quietly been building up huge taxpayer-funded pensions. They will be handed tax-free six-figure lump sums on retirement, and annual payouts from the age of 60 of at least £55,000 – guaranteed for life.
Nearly 300 directors on NHS trust boards have accrued pension pots valued at £1million or more; At least 36 are sitting on pots in excess of £1.5million – with three topping a staggering £2 million; The NHS pays a staggering 14.3 per cent on top of employees’ salary towards their pension – almost five times the average of 3 per cent paid in the private sector…
Back in 2013, I got very upset when I learned that senior bureaucrats at the IRS awarded themselves big bonuses, notwithstanding the fact that the agency was deeply tarnished by scandal because of …
You can take this to the bank. Every innovation in the production of every good or service – anything that lowers costs or increases quality – originates on the supply side of the market. There has never been a successful innovation that originated on the demand side.
This principle applies to health care in spades. For as long as I have been in health policy – more than 30 years – I have been dealing with non-doctors who have a deep, abiding desire to tell doctors what to do. Yet I don’t know of any example anywhere in the world where this approach has ever worked.
If the definition of insanity is repeating the same thing over and over again and each time expecting a different result then “insanity” is the appropriate word here. The Obama administration has spent millions of dollars on pilot programs and demonstration projects in a fruitless attempt to discover how to better practice medicine. It has spent millions more trying to herd Medicare patients into Accountable Care Organizations – super HMOs with financial incentives to hit quality measures. That hasn’t worked either.
…All too often, insurance companies are asking for prior=authorizatons for services to be rendered and all too often they result in denials. I sometimes spend days in the battle of prior-authorizations trying to get a needed test orders. Many times I end up in a phone battle with the medical director of any given insurance company. Most often they are understanding what my patients need and will give approval. But, in recent weeks, denials have been more common. And these decisions are determined by someone who has had no direct contact with my patient or even spoken with them.
Constitution-defending Conservative Christian Texan Physician Patient Survivor Mother of 4 daughters Small business owner on a mission to get government out of medicine. I have read The Patient Protection and Affordable Care Act (Obamacare), tweeted it and studied it. I will not implement, comply with it or let my patients live or die by it. Co-Founder AmericanDoctors4Truth.org
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