I generally disapprove of the government using tax money to create incentives for people to do things the government wants them to do. That's why I support a flat tax, even though there are potential difficulties that might prevent the elimination of all current deductions.
Anyway, I was reading the provisions of the new Medicare law and one incentive struck me as particularly misplaced:
It will provide benefits for coordinated care for people with chronic illnesses, and will increase payments for doctors administering mammograms in hope that more are given.It is perfectly proper for patients to factor in the cost of treatment when they're considering seeing a doctor or having a test. The problem here though is that this incentive is paid to doctors, who will presumably recommend more mammograms simply because they're paid more by the government to perform them! In a non-subsidized system, doctors would make profits by pricing their services to best take advantage of their patients' economic demand. However, when patients pay nothing for medical service, doctors can charge the government anything they want... which is why the payements allowed for certain procedures are limited by law.
By increasing payments to doctors for mammograms, Congress rightly expects that doctors will encourage more of their patients to have them performed, whether they're medically necessary or not. Thus, it's Congress who has made the medical decision, not a patients or doctors. This is exactly wrong, and it's an excellent example of why the government shouldn't be meddling in what should be private affairs.
"who will presumably recommend more mammograms simply because they're paid more by the government to perform them"
well said. i've been livid about this for a while. why are doctors so easily manipulated by economic self interest? maybe i'm an idealist, but i thought it was about medicine, not money.
and you what really gets me, is that if they do the above, which now they will, i'll be more breast cancer cases in women are caught early and stopped. and what did we have to do to get there? bribe the doctors. so much for there high moral ground, they're no different than anyone else.
I haven't read the bill in detail yet, but here is another landmine for seniors. Apparently, private insurers will be prohibited from offering gap coverage once the drug benefit is fully in effect in 2006. According to this summary, there is NO coverage for prescription costs between $2,250 and $5,100 per year (except for the indigent.) That $2,850 gap cannot be insured against.
How many other goodies are in this monster?
One wonders comparatively how many deaths occur from breast cancer as complications from obesity. And why there aren't any incentives for HMOs to fund early intervention to those that are morbidly obese, such as gastroscopic surgery.
But that would mean actually wanting incentives... if we are going to have incentives, lets have them for a disease that is the most wide-spread, such as heart disease, and diabetes.
Gator - Not that I disagree with your comment (or Michael's post) but just wanted to comment that I do believe that breast cancer is one of the main causes of death of women in this country. Especially for those over the age of 55... I'll have to look and see if I can find statistics for that.
Jason: Uh, of course doctors are just like the rest of us. How could you possibly expect anything else? And they should be motivated by economic factors. That's not the problem. The problem is that the government shouldn't be setting up atrificial economic incentives to nudge doctors towards certain forms of treatment -- patients should make the decisions on their treatment based on their own ability and willingness to pay.
Dave: That's pretty strange if the law prohibits "gap coverage", and it sounds unjust to me.
As for breast cancer, yes, it's a big problem, and women should certainly be tested. But they should choose to do so on their own, not because their doctor gets bribed to push the test on them.
of course you are right, they are no different. however, i think there is a feeling of arrogant condescension and often downright unwillingness to engage in a patient's exploration of ideas regarding what their symptoms are/mean and what they would like to do about it. it's this condescension that i think gets me so upset when they show themselves to be as regular as everyone else.
I still don't think economic incentives, where ever they come from, should be indicating treatment. it seems to me that symptoms and good medicine should be, and i do fault doctors for being responsive to market forces in this regard. market forces do not create disease, nor suggest the cure. i don't think we're asking doctors to be super-human to diagnose and treat according to medical need and not economics. I think we are asking for a baseline in ethical awareness that is justified when considering the difficulty and exclusivity in becoming a doctor.
All in all I agree with you on the details of the medicare bill and that it is not appropriate. I am also upset that it will work to increase early detection of breast cancer.
The reason market forces don't lead to good health care is that market forces in the health care industry are horribly distorted by government interference. If (more) people had to actually pay for the costs of insurance and treatment, and the costs weren't paid for by other tax-payers, people would make much more intelligent decisions.