I think you’re allowing your defensiveness to bias your reading of what I write. Each of your paragraphs is predicated on a misreading of a particular element of my proposal. For example, your first argument, objecting to what you perceive to be arrogance, completely misconstrues the point I made. My argument here is no more complicated than “He who pays the piper calls the tune”. It is economically untenable to have Party A pay for work done by Party B at the latter’s discretion. In every case where that is done, Party A inevitably ends up feeling cheated. And I think it is fundamentally unfair for anybody—including physicians—to expect freedom to make decisions affecting others while evading responsibility for the financial consequences of those decisions. Our society has developed all sorts of extremely complicated mechanisms for matching decision-making power with financial liability. True, there are still plenty of violations of that basic goal, but we all agree that those violations constitute flaws in the system.
I understand your point, but you’ll have to excuse me for misconstruing it. You need to understand I’ve already been there, done that. I have dealt with insurance companies who refused to allow a patient to have a particular test that was truly necessary. I was in the position of dealing with a person who apparently had no more than a high school degree who was looking at a computer screen and decided that my patient didn’t meet the criteria for getting a head CT. Apparently the program didn’t differentiate between ” the patient has a bad headache” and “the patient is screeming in pain with the worst headache of his life”. The answer I got from the insurance rep was. “well we’re not sayin he can’t have the CT he can just pay for it himself”. I do find it arrogant that a person can speak to someone of clearly greater training with that degree of detachment assured of the correctness of their decision because a computer program told them they were doing the right thing. Your comment sounded hauntingly like that very situation.
argue that physicians do not order tests to advance their financial interests. I disagree. A great many physicians order tests whose diagnostic value is slight, but they do so to protect themselves against litigation. I don’t blame them one bit—we’ve set up the incentives to induce them to do that. The problem is not with physicians, the problem is with a system that motivates reasonable people (physicians) to waste resources.
I didn’t actually say that. Here You have misread what I said. What I said is that a very high percentage of the tests ordered by me ( and most primary care docs) are not done in their own office and therefor do not benefit me (them). I agree that a good percentage of these tests are done for CYA ( cover your ass) reasons and if a legitimate effort were made to limit litigation, this would decrease substantially. However, to handcuff a physician and not allow him to order these tests without tying that directly to such limits would be disastrous for physicians. I understand you are trying to do that I am just not optimistic that you can.