For anyone, especially frail, cognitively impaired seniors who might be perplexed by sales pitches from doctors and hospitals trying to influence their choice of care, and for the confused hoi polloi who aren't even sure what sorts of services they really need, Goldhill explains, "organizations will develop," under a variety of payment models.
"They might say, 'We'll take care of all your care for an annual membership fee,' and there'll be discount clubs and pre-pay clubs. There will be the type of variety of care and payment that we've come to expect in everything else in our lives."
I told him I consider that scenario impossibly confusing, not just for older people with complex health issues and limited thinking skills, but for me as well.
I also think it would be ripe for charlatans who'd take advantage of the gullible and frail. Human nature being what it is, we'd need another entire layer of watchdog bureaucracy to make sure the people who sold these services were qualified to do so. And another layer of enforcement power to stop them from hurting people, hopefully before they've already done harm.
Goldhill argues that "third-party service" report cards would spring up, such as the safety scores produced by the Leapfrog Group, whose board he has joined, to "actually distill information in a form that's of use to consumers" to guide their choice of hospitals and doctors.
But Goldhill forgets that much of this information used by the Leapfrog Group, and most of it used by many other third party companies like U.S. News & World Report or Truven Health Analytics, comes from Medicare claims data, and other hospital reports, and much of it is posted on Hospital Compare.
I noted that the Patient Protection and Affordable Care Act requires that hospitals be penalized for poor outcomes, such as mortality and readmissions, and hospital-acquired conditions like falls, and hospital-acquired infections.