It’s the Price Stupid is the title of a seminal paper in Health Affairs that concluded that the United States pays more for health care and receives less than in other developed countries.
It is also a theme resurrected by Alec MacGillis in a Washington Post article last week.
The argument goes like this. The United States pays more for health care than anywhere else on the planet, as much as 50% more than the average for other developed countries.
Yet we get fewer services; fewer physician visits, fewer hospital admissions, fewer days in the hospitals. It doesn’t take a Ph.D. statistician to conclude that we are paying too much per unit of care.
Accountable care organizations. Patient centered medical homes. Episodes of care.
What do they have in common?
They each attempt to use payment incentives to encourage disparate practitioners to collaborate to achieve quality outcomes.
A common purpose
Socialized medicine is progress
The key word is collaborate. Countless research indicates that when doctors work in teams, they achieve better results at lower costs. It is this transition from doctor as solo practitioner to doctor as a member of a team that is the key challenge to reforming our health care delivery system.
This transition from solo craftsman to a member of a team is not new to the evolution of our economy.
It is how Karl Marx differentiated capitalism from the mercantilist economy that preceded it. He called it the socialization of work. It was this contradiction between the socialization of work and the private ownership of the means of production – capital –that was supposed to be resolved by the socialist revolution.
Karl Marx recognized that this socialization of work brought tremendous increases in productivity to the world economy. Continue reading →
If there were a continuum leading away from fee for service reimbursement toward a global payment methodology, then the accountable care organization is furthest removed from fee for service reimbursement . The patient centered medical home brings us closer to fee for service only because it does not encompass inpatient hospital care. Continue reading →