You should care a lot about how health reform will affect your doctor. The reason: it will also affect you.
Here's what's happening: hospitals are merging and they are acquiring doctors. In the process, they are making the market less competitive, gaming third-party payment formulas and doing other things that make our health insurance premiums and our taxes higher than they otherwise would be.
None of this is the result of any plan the administration ever announced, however. What did the Obama administration intend to happen? The clearest explanation of their vision of health reform comes from Harvard Medical School Professor Atul Gawande, who thinks that medicine should be more like engineering — with all doctors following the same script, rather than exercising their individual judgments:
This can no longer be a profession of craftsmen individually brewing plans for whatever patient comes through the door. We have to be more like engineers building a mechanism whose parts actually fit together, whose workings are ever more finely tuned and tweaked for ever better performance in providing aid and comfort to human beings.
Karen Davis, president of the Commonwealth Fund, explains what this will mean for the organization of medical practice:
The legislation also includes physician payment reforms that encourage physicians, hospitals, and other providers to join together to form accountable care organizations [ACOs] to gain efficiencies and improve quality of care. Those that meet quality-of-care targets and reduce costs relative to a spending benchmark can share in the savings they generate for Medicare.
To assist in this effort, millions of dollars have been spent on pilot programs and demonstration projects to find about "what works" so the ACOs can go copy them. We've had demonstration projects for coordinated care, integrated care, medical homes, electronic medical records, pay-for-performance and just about every other faddish idea. Unfortunately, the Congressional Budget Office has found in three separate reports that that none of this is working (see here, here and here.)
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