Free Marketeer's Healthcare Scheme Would be Chaos
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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