Posted by
Andrews on Tuesday, June 23, 2009 4:27:26 PM
I have mentioned many potential problems with the concept of universal health care, whether it is done through outright socialization or through universal insurance (though that
will inevitably lead to nationalized health care). One thing I did not consider, however, was a topic mentioned briefly in
a recent WSJ opinion piece.
The author brought up many topics, but one thing he mentioned was the confusing system of coding for diagnoses and treatments and the potential for auditors to find fault with the coding used. Of course, this is already a problem for those doctors dealing with government insurance, but it will get worse with universal coverage.
How so?
Well, right now government insurers have the model of private insurance to set their practices. Admittedly, the do not always follow private practices, but the doctors still have private insurance, and private billing practices, to fall back upon. If a government auditor says a doctor is prescribing too much of X, or performing too many procedures of type Y on medicare patients, the doctor can point to his non-medicare patients and explain that the procedures, the prescriptions or the prices are the same and are justified.
Once every patient is a government patient, this will not be possible, and we will be left with a confrontational relationship between doctors and the government.
Perhaps the best model is the IRS. The IRS administers a massive body of arcane, confusing rules, where many decisions amount to judgment calls that professionals may decide honestly in different ways, and yet the IRS has a tendency to assume any case where they find error is a case of intentional fraud.
Likely medicine will become quite similar. Doctors have many situations where honest doctors may make different calls, where treatment decisions may be different, where even diagnoses may be different. However, once the government gets involved, it is likely any difference of opinion between government auditors and doctors will not be seen as a difference of opinion, or even a mistake, but as fraud. And this will likely lead to an excessively uncomfortable situation for doctors, possibly driving many out of the practice of medicine, as has happened in many countries which instituted socialized medicine.
Nor will that be the only problem. I can foresee an additional problem. Doctors are currently used to ordering diagnostic tests as "defensive medicine". For example giving CAT scans to anyone suffering even the mildest head injury, just to avoid any potential future law suits. Once the government is involved, I doubt they will want to pay for such "costly and needless tests", yet I do not see the Democrats, quite friendly with the trial bar, acting tin any way to cut off malpractice liability. So, doctors will be left with three choices: Skip the tests and risk massive liability, eat the costs of those tests and risk bankruptcy, or try to fake a diagnosis which supports the defensive medicine, risking fraud charges and causing more strife with government auditors.
Does anyone really believe that such a system will attract the best and brightest? Or that those operating in such an environment will be able to offer the conscientious service we would want from a doctor? Or is it likely we will get gruff, taciturn service from the most mediocre of physicians, making decisions dictated by politics and fear of audit more than the needs of the patient?
Is providing care to
8-10 million indigent really worth consigning 290 million more to such a fate? Or is there not a better solution?