Incentive to always do more penalizes effective caregivers
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Three thoughts (regarding “Doc groups vow to lobby hard for SGR fix in Senate,” Nov. 23 ).
Republicans seem to be playing “catch-up” in the debate about healthcare reform, of which fixing the Medicare payment formula is a part. I think this is basically because they’ve made a political decision to stonewall anything the Democrats come up with, rather than seriously think about the problem and its various practical solutions.
Things cost what they cost. Pretending that a budget is somehow “fiscally responsible” by not including the cost of something (like the Iraq war, for example) is an old political smoke-and-mirrors trick. Thanks to the Internet, blogging and other new sources of information, this kind of thing is thankfully under serious attack.
The idea that the way to control cost is simply not to pay for something just doesn’t work. Whatever “it” is, it’s going to get done unless the incentives and disincentives around it are adjusted in the proper way. Currently, there is no incentive for any provider of healthcare services to provide cost-efficient care. Quite the opposite: Look at the experiences of systems like the Mayo Clinic, Geisinger Health System and Intermountain Healthcare. Basically, they are penalized for providing cost-effective care. The incentive is always to do more. With that incentive in place, things will get done, money will be spent and Congress will continue to pretend that it isn’t really costing more because they haven’t included it in the budget, but instead take care of it in last-minute “emergency” legislation. The yearly sustainable-growth-rate fix is a case in point.
Gregory M. La Gana, M.D.Bridgewater, N.J.
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