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DrRich's Grand Unification Theory of Health Care - Contents - SECTION 1 - The importance of the doctor-patient relationship and why we can't have it anymore SECTION 2 - The truth about health care rationing SECTION 3 - Health Care 2000 - how it got this way SECTION 4 - Secrets of managed care SECTION 5 - Portrait of a modern HMO SECTION 6 - The Clintonians Strike Back
SECTION 7 - Rationing and Death - Covert rationing and end-of-life care |
Considering
the recent doings of the Gekkonians, by now we might feel quite
sympathetic toward the Clintonian notion that our health care problems
would best be resolved not by free market economics, but by new and better
regulations. We might even be cheered by
the fact that the Clintonians
have not just been sitting idly by these past few years, wringing their
hands in despair and wishing things had turned out differently.
Indeed, this time has been very busy and fruitful for them.
Unfortunately, in practice the Clintonians threaten to do as much damage to our health care system, to the doctor-patient relationship, and to fundamental American principles as do the Gekkonians. The regulatory imperative, like the profit imperative, tends to takes on a life of its own, and to completely overwhelm the health care system’s mission to operate for the public good.
The anti-fraud imperative
In his 1994 State of the Union Address, President Clinton, still fighting hard for passage of his health care reform initiative, declared dramatically that that our health care system “is riddled with inefficiency, with abuse, with fraud, and everybody knows it.” This line gained him a huge bipartisan round of applause. And why shouldn’t it? Everybody hates abuse and fraud in health care.
The mandate to root out fraud in the health care system is an extraordinarily powerful one. Everyone agrees that health care fraud is an inexcusable crime, and believes that perpetrators of real fraud should be tracked down vigorously and prosecuted fully.
Until recently, however, federal programs like Medicare were very lax about fraud detection, and did not have the will or the systems in place to look for fraud. Thus, it was relatively easy for unscrupulous individuals to get away with even the most obvious fraudulent practices. Many scam artists, organized crime syndicates, and drug-related money launders saw the $250-billion-a-year doled out by Medicare as a huge pot of unguarded money. This historic laxity with public funds is inexcusable, and efforts to get tough with fraud should be and are a priority.
Unfortunately, the anti-fraud imperative also presents an irresistible opportunity for the Clintonians to gain control of physicians’ behavior, and thus of the health care system, through the regulatory process. The anti-fraud program that is being put into place today is virtually guaranteed to prevent doctors, whether they’re committing fraud or not, from making the patient’s needs their paramount concern. Physicians who don’t keep the wishes of the regulators at the top of their list of priorities are risking everything.