Does the Healthcare Bill skip the basics?

The last time I checked… if demand is increased relative to supply… prices go up. So if we add millions to the healthcare roster while at the same time the incentives for clinicians to excel in their profession are diminished, isn’t the demand for care increased at the same time the supply of care providers is either stagnant or potentially declining. As there has been in the past, those who have succeeded and been rewarded for their achievement have a choice to either stay in the system or dial back their contribution as the conditions they exist in become less hospitable. A star athlete in high demand is likely to seek out the team who will provide compensation more aligned with his/her self perception of value.



I would argue the logical outcome will be one where there is an effort to maintain the standard of living and reward for professional ability. If this is not the case then altruism would have to prevail… That is to say, a unit of work effort would have to be maintained despite less money being provided for that unit of work effort.

People have a strong tendency to want their standard of living to grow not decline… in a worst case scenario, there will be an effort to at least maintain the status quo. So if there is less money proffered for a unit of work effort then the work effort must be reduced for the new, lower reimbursement.

In the realm of healthcare this means less time spent with each patient or on each procedure. As I debated in my last blog, I don’t think the solution lies in iterative clinical process improvement. Rather, “tightening the bolts” on a clinical process will likely result in lower quality outcomes. This has been seen, researched and proven in numerous studies but is outlined in a nice way by John Goodman's Health Policy Blog. There is no doubt our system has cost more to run… but there has been a corresponding benefit to the US population.

So, again, I argue for operations efficiency. Altruism is not likely going to save the day when it comes to sustaining the quality of our national healthcare system. History tells us we would be disappointed if this were to be held as a hope. It’s also the reason the Market Economy has worked so well for us in the USA and why we have been able to achieve the leadership position we enjoy.

Is it just me or has this debate been noticeably absent from the healthcare reform bill and the public option debate?