No, not the one that said everyone who likes their current health plan can keep it, though that clearly is a whopper. This is the one that fascinates me:
[Obama said] if doctors have incentives to provide the best care, instead of more care, we can help Americans avoid unnecessary hospital stays, treatments and tests that drive up costs.
What he is referring to is the fact that if doctors prescribe more procedures, they make more money.
I spent years as a consultant working with incentive programs in corporations. They are very tricky things. It is much harder to create incentives for the wrong behavior than the right behavior. But I don't think you need similar experience to dissect this plan. Because there is absolutely nothing of real substance in this plan, or any HMO has discovered, that will truly create incentives for "the best care." It just doesn't work with doctors. I know doctors, and when Obama says "best care" he means saying no to a lot of things. That is not how doctors would understand the phrase. I worked with Kaiser-Permanente for about a year as a consultant, and this was a constant source of friction between the Kaiser business people and the Permanente medical staff.
Really, all Congress and Obama are doing is twiddling one knob called "payment model" and the knob only has two settings - either create incentives for the doctor to do a lot for the patient by paying for individual services, or create incentives for the doctor to do as little as possible for the patient and resist every plea for a test or specialist referral. Basically, Obama's intention is to flip the switch from the former to the latter position, similar to what is being done currently in the Massachusetts health plan with switching to capitated payments from fee for service for doctors, and similar to the strong HMO model that pissed so many people off years ago that many states banned practices Obama is implementing nationally.
Yeah, I know the response, that somehow "preventative medicine" will reach the golden mean. Forget it. Preventative medicine is great as a spur to individual well-being, but does little to reduce total system costs**. Waving around the flag of "preventative medicine" is about as believable as when politicians say they will make up budget gaps with savings and efficiency. Basically, the next time we see either will be the first time.
** This kind of thing always sounds heartless, but for example it is actually cheaper not to find a cancer until its almost too late. An expensive operation may be called for, but a quick death is actually cheap for the system. Finding a cancer early means expensive treatments now, and probably expensive treatements later in a longer life. I much prefer the latter, but it is more expensive. You can't get around that. The big wins in reducing health costs rom preventative medicine are in public health and nutrition, and most of those battles are won. There may still be some savings in pre-natal care, but even that is iffy.
