With respect to payment reform, an important tweak to the direct primary care argument goes like this: Insurance is about pooling risks associated with somewhat rare adverse outcomes. Primary care is consumption. It's not relatively rare, it's not adverse. It is entirely predictable. It needs be taken completely out of the "insurance" definition. It's as if your auto insurance provided unlimited gas and car washes. From this change, we might see primary care delivery escape the expensive platform of hospitals. Why isn't my primary care doctor affiliated with my gym? Or why can't my gym create a simple primary care subscription model?
You mentioned the few questions to ask anybody and I have asked many times why it is so complicated and obtuse. It never made common sense why my medical history has to be repeated in nauseating detail with every new provider. A hospital CFO told me that healthcare systems want to be siloed to form a barrier to entry. Seems like a prevailing theme that the federal government also provides those barriers, the big systems can afford the expensive lobbyists.
I'm afraid that Joe Lonsdale's partner's ideas do not impress me.
So far, all that has been accomplished by the electronic medical records drive has been to put small physician practices out of business. They have not been able to absorb the overhead involved in implementing these symptoms, so that they have been forced to lose their independence, primarily to hospital-owned conglomerates.
The other ideas also are beside the point. If you change the metrics for compensating health care providers, in the end all you do is give them a different system to be gamed. What you have to do is reduce the incentive for *consumers* to obtain procedures that have high costs and low benefits. That means doing something unpopular, like making them pay out of pocket for a higher share of spending or else denying them coverage for some procedures.
All good points, but how about questioning how much "treatment" may be unnecessary? My own experience is that many physicians, by way of generating more office revenue for their practice, may tend to over-treat, requesting more visits than necessary, more drugs than necessary, and so forth. My sense is that this is a result of their training in medical school, as well as the need for CYA in the case of potential legal liability in our litigious culture. More treatment, whether paid out-of-pocket or federal and/or insurance subsidies, doesn't make us healthier.
With respect to payment reform, an important tweak to the direct primary care argument goes like this: Insurance is about pooling risks associated with somewhat rare adverse outcomes. Primary care is consumption. It's not relatively rare, it's not adverse. It is entirely predictable. It needs be taken completely out of the "insurance" definition. It's as if your auto insurance provided unlimited gas and car washes. From this change, we might see primary care delivery escape the expensive platform of hospitals. Why isn't my primary care doctor affiliated with my gym? Or why can't my gym create a simple primary care subscription model?
Joe: Why not extend COBRA from 18 months to up to Medicare eligibility age?
You mentioned the few questions to ask anybody and I have asked many times why it is so complicated and obtuse. It never made common sense why my medical history has to be repeated in nauseating detail with every new provider. A hospital CFO told me that healthcare systems want to be siloed to form a barrier to entry. Seems like a prevailing theme that the federal government also provides those barriers, the big systems can afford the expensive lobbyists.
I'm afraid that Joe Lonsdale's partner's ideas do not impress me.
So far, all that has been accomplished by the electronic medical records drive has been to put small physician practices out of business. They have not been able to absorb the overhead involved in implementing these symptoms, so that they have been forced to lose their independence, primarily to hospital-owned conglomerates.
The other ideas also are beside the point. If you change the metrics for compensating health care providers, in the end all you do is give them a different system to be gamed. What you have to do is reduce the incentive for *consumers* to obtain procedures that have high costs and low benefits. That means doing something unpopular, like making them pay out of pocket for a higher share of spending or else denying them coverage for some procedures.
All good points, but how about questioning how much "treatment" may be unnecessary? My own experience is that many physicians, by way of generating more office revenue for their practice, may tend to over-treat, requesting more visits than necessary, more drugs than necessary, and so forth. My sense is that this is a result of their training in medical school, as well as the need for CYA in the case of potential legal liability in our litigious culture. More treatment, whether paid out-of-pocket or federal and/or insurance subsidies, doesn't make us healthier.