More thoughts on doctors’ offices as campaign offices

In a recent post, I asked for your thoughts on how you would feel if your doctor posted an anti-health reform letter in his waiting room. Link
The letter was a direct quote from one posted in Dr. Hal Scherz’s urology clinic in Atlanta. Scherz is president of Docs4PatientCare. For all I know, Scherz is a talented and knowledgable urologist. But let’s look for a minute at his confusion about what he calls “ObamaCare.”
To quote Scherz again:
“Dear Patient: Section 1311 of the new health care legislation gives the U.S. Secretary of Health and Human Services and her appointees the power to establish care guidelines that your doctor must abide by or face penalties and fines.”
Sounds serious. Guidelines! Penalties and fines!
Should we be worried? That depends. We have to consider the alternative first, which, in this case, would be for Medicare to pay doctors without any regard to whether they are offering appropriate care.
Don’t you think doctors should be accountable for the quality of care they provide?
Or is it impossible to figure out whether doctors are practicing good medicine?
As it turns out, the science of measuring quality of medical care is still in its infancy, or maybe entering its preadolescent period, but there’s enough evidence in enough domains of medicine, that it would be irresponsible to ignore our ability to tell whether doctors are doing what they ought to do.
Yet Scherz would have us believe that no one other than the individual doctor is in a position to judge that doctor’s professional competence:
“In making doctors answerable to the federal bureaucracy this bill effectively makes them government employees and means that you and your doctor are no longer in charge of your health care decisions.”
This is horribly confused. Let’s look at a couple of errors Sherz made.
Error #1: Saying that doctors would be government employees. Physicians have made gazillions of dollars caring for Medicare patients over the years. Yet now that the Medicare office is planning to develop some guidelines to assess the quality of such care, with modest financial incentives to encourage doctors to follow such guidelines… only now does Scherz think doctors are becoming government employees?
Error #2: Concluding that a financial incentive to follow guidelines suddenly means that you and your doctor are no longer in charge of your health care decisions.
Has Dr. Scherz ever interacted with a health insurance company?
Medical decisions haven’t been exclusively controlled by doctors and patients for quite some time. Some doctors perform excessive numbers of procedures on their patients, either out of ignorance or greed. Insurance companies have been trying to reduce such overutilization for a few decades now.
Now the government wants to promote some well-established clinical guidelines, backed by evidence from medical literature, vetted by leading medical organization, and suddenly “big brother” is controller our doctor’s every thought?
I don’t know if Scherz is legitimately confused about the health care reform legislation, or if he is simply worried that any effort to control Medicare expenditures will reduce his sizable income.
Either way, we shouldn’t let doctors scare us off from developing a Medicare system that holds health care providers accountable for the quality of their care.
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PeterUbel