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Free Marketeer's Healthcare Scheme Would be Chaos

Cheryl Clark, for HealthLeaders Media, February 28, 2013

The movement is accelerating, with some 90 measures now posted on the government site, from seven new measures of emergency room speed to whether the hospital overused potentially harmful imaging services.

If Medicare is no longer in the picture paying claims, how will it have the same clout to collect such important information for every hospital across the country so these third party services can use it? Likewise what it learns from quality reporting initiatives about doctors.

But government regulations and Hospital Compare data apparently don't impress Goldhill, who would rather let hospital and physician marketing campaigns, and referrals from satisfied friends and relatives, guide choices.

Providers will not be tamed by accountable care organizations and bundled payments, but will figure schemes to get around them, and prices will continue to soar, he says.

"Let's stop saying, 'let's do it better and smarter and cleverer with a new type of regulation, and here's a new rule that will  fix everything,'" he says. "Let's stop kidding ourselves. It's a fundamental structural issue about the incentives in the system. And the incentives in the system are very clear. Like anybody else, providers in healthcare serve their customers.  And their customers are the insurance companies and CMS."

He continues, "Only in healthcare do you get away with this high priest nonsense that unaccountable institutions dominated by insiders (which he identifies as CMS and the insurance companies) doing the best for the outsiders (patients) somehow can continually drive improvement. It's absurd. It's disproved by any sort of institution we have doing anything."

I wanted to mention that with a market force like he seems to advocate, we might not hear from the unhappy customers, the ones who might not have done so well or perhaps not even survived, the care they received.

I'm no apologist for Medicare or health plans and have had some coverage battles with private plans myself over the years. But I fear that Goldhill is catching a ride on national momentum of anger and frustration. He's right that the systems need to change. But I don't think his solution is the way to go about it.

Rather, it would make the system far more difficult for patients who may be baffled by myriad claims about necessity, quality and effectiveness, with nowhere to find data to back it up.


Cheryl Clark is senior quality editor and California correspondent for HealthLeaders Media. She is a member of the Association of Health Care Journalists.
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5 comments on "Free Marketeer's Healthcare Scheme Would be Chaos"


Wayne Wasden (3/17/2013 at 4:06 AM)
Ms. Clark, You should be ashamed of yourself. Your liberal sermonizing has been placed in stark comparison to individual empowerment, accountability and responsibility. Mr. Goldhill has simply stated facts and the truth about how markets and human nature work. Last I looked market forces continue to work extremely well in the U.S. system, especially when they are not tinkered with or controlled by people who view themselves as wiser than the consumer. It is also a sad fact that this discussion for a significant change to a tried and successful way of doing business will never be elevated because of those who currently exercise control over market forces. And a single payer systems does not significantly alter the incentives so clearly dominating behavior. There is no more broken system than the U.S. Healthcare System with it's incentives clearly exposed and articulated by Mr. Goldhill. Ms. Clark, with all you clout and contacts, do all you can to move this discourse to a higher level. Bravo Mr. Goldhill

MayoVictim (3/6/2013 at 5:03 PM)
There's a simple solution to the US healthcare system. It is just to adopt a European style single payer system. The Europeans have better healthcare outcomes. It costs much less than the US system and when I lived and worked in the UK and Europe I never heard anyone in the medical industry complain about their remuneration. Of course the AMA and their handmaiden in congress have a done good job demonizing what they label as "socialized Medicine" but I can tell you that from my personal experience as a patient and worker in the healthcare industry it's way better than what we have in the US. I'll now wait for nonsense comments about waiting lists and death panels.

MBRose (3/1/2013 at 1:46 PM)
Bravo Mr. Goldhill! Perhaps by thinking far outside the box of 'standardized care' schemes and shaking up the illness healthcare system currently worshiped in this country, true life changing improvements might happen. Maybe the 'Tippong Point' has finally been reached and society will move forward in handing the power for self-care back to the individual and out of the hands of insurance companies and physicians, who have NOT improved outcomes or increased longevity and quality of life in decades...but have become some of the wealthiest and most powerful individuals and corporations in the process. Change, big change, never happens easily or smoothly. Yes there might be some missteps along the way. However it is time to do something differently...anything differently. We have followed this insanity for far too long, doing the same kinds of things over and over again, expecting improved outcomes and results. Isn't that the definition of insanity? Yet we have bought the bill of goods, hook, line, and sinker each and every time! I say bring on a bit of chaos and let real change begin to happen.