An article in New York Magazine endorsing Obama provides several insights into the different ways of thinking that are in discussion in the nation. One line is particularly instructive: "Bipartisan panels of economists had long urged Medicare to reform its payment methods to curb perverse incentives by hospitals and doctors to run up costs as high as possible; Obama overcame fierce resistance in Congress in order to craft, as part of Obamacare, a revolution in paying for quality rather than quantity."
There is a lot here. First, it seems that there is opposition to the substitution of quality for quantity, many actually preferring quantity. Perhaps there is a "quantity lobby" that will be injured if quality is substituted. Moreover, they seemingly oppose quality. They clearly are abusing the system, are benefiting from inferior medical care and are opposed to health care improvement. Secondly, the original Medicare plan, as crafted by Congress, somehow failed to do this right. There is even the implication that the "perverse incentives" are "by hospitals and doctors'" as if they, and not government, wrote the law and are responsible for this perversion--a law, by the way, opposed by almost all physicians when it was created. This new law apparently is written by new people who know how to improve matters. The new leaders are of a different breed, have better vision and higher goals. Third, it is obvious that structuring the law makes the hope a reality. The answer is there just waiting to be uncovered by honest and well-meaning leaders--this despite the fact that most of the law is actually not very tight and is waiting for numerous committees and agencies to flesh it out. Legislating the goal makes it so.
These people live in a simpler world than most. A hospital once formed a committee to establish criteria for appendectomy; they met every week for 18 months and never came to a consensus. Amgen recently reviewed 53 landmark cancer studies and found 47 were not reproducible. 47!
Real life is hard and acting as if it is not or that some selected few have greater insight than the rest of us is dangerous. It is reminiscent of ancient societies where certain birth brought a birthright and where magic men with rabbit entrails and doves could read the implications of the past and future.
We may never step into the same river twice but it's the same old water.
There is a lot here. First, it seems that there is opposition to the substitution of quality for quantity, many actually preferring quantity. Perhaps there is a "quantity lobby" that will be injured if quality is substituted. Moreover, they seemingly oppose quality. They clearly are abusing the system, are benefiting from inferior medical care and are opposed to health care improvement. Secondly, the original Medicare plan, as crafted by Congress, somehow failed to do this right. There is even the implication that the "perverse incentives" are "by hospitals and doctors'" as if they, and not government, wrote the law and are responsible for this perversion--a law, by the way, opposed by almost all physicians when it was created. This new law apparently is written by new people who know how to improve matters. The new leaders are of a different breed, have better vision and higher goals. Third, it is obvious that structuring the law makes the hope a reality. The answer is there just waiting to be uncovered by honest and well-meaning leaders--this despite the fact that most of the law is actually not very tight and is waiting for numerous committees and agencies to flesh it out. Legislating the goal makes it so.
These people live in a simpler world than most. A hospital once formed a committee to establish criteria for appendectomy; they met every week for 18 months and never came to a consensus. Amgen recently reviewed 53 landmark cancer studies and found 47 were not reproducible. 47!
Real life is hard and acting as if it is not or that some selected few have greater insight than the rest of us is dangerous. It is reminiscent of ancient societies where certain birth brought a birthright and where magic men with rabbit entrails and doves could read the implications of the past and future.
We may never step into the same river twice but it's the same old water.
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