health policy · narrative medicine · news

Plus ça change

House Approves Senate’s 1-Month Medicare Doc Fix.

This dance happens with startling regularity, like the cycles of the moon or the flowering of the sukebind.  Medicare payment cuts are always looming; Congress always dallies; and at the last minute: swoop! cut revoked — until next month.  It’s Victorian melodrama for a the social network age, and we’re all Pauline, tied to the tracks.

This is the worst possible way to address the Medicare expense issue. According to the article above, Medicare is based on a 1997 formula tying Medicare payments to a percentage of the GDP. That’s crap. Why should physician payments be artificially pegged to the GDP? Shouldn’t the formula be revised to account for the technology-and-pharmaceutical explosion since 1997?  And would someone show me a breakdown of Actual Cost — of every health care dollar, how many cents go to prescription drugs, how many to running an office, etc? The whole process is shrouded, even from one who is in it and is actively seeking this information.

Lydgate, whose primary quality is his ability to rock some snazzy suspenders

Over Thanksgiving, I read Middlemarch, a provincial epic by George Eliot. (As I said to myold-lady-television-watching buddy, Cranford on steroids.) One of the characters, Tertius Lydgate, is a young physician, new in town and full of ambitious plans for revitalizing the practice of medicine. He’s a decent doctor and even manages (by luck or skill, it’s never quite clear) to save a young man from typhoid. But then he incurs the wrath of the town when he decides to charge for his services!  The nerve!   Apparently in the early 19th century, physicians would charge for the drugs they dispensed, but Lydgate prefers to leave that to the apothecary (pharmacist) and focus on what he has been trained to do: diagnosis.  But the town is up in arms about his chutzpah of demanding payment for something intangible like thought. (Never mind that Fred Vincy, the patient, is walking around town as tangible as you please.) The whole episode sounded exactly like the debates on health care reform.

Plus c’est la même chose.


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