How Government Killed The Medical Profession
Details how the US government has neutered the clinical ability of doctors and their facilities through regimentation and price controls, and made proper health care more expensive by creating a corrupt two tier system.
Each diagnostic code is assigned a specific monetary value, and the hospital is paid based on one or a combination of diagnostic codes used to describe the reason for a patientâ€™s hospitalization. If, say, the diagnosis is pneumonia, then the hospital is given a flat amount for that diagnosis, regardless of the amount of equipment, staffing, and days used to treat a particular patient.
Named the Resource-Based Relative Value System (RBRVS), each procedure code was assigned a specific value, by a panel of experts, based supposedly upon the amount of time and labor it required. It didnâ€™t matter if an operation was being performed by a renowned surgical expertâ€”perhaps the inventor of the procedureâ€”or by a doctor just out of residency doing the operation for the first time. They both got paid the same.
One of my colleagues, a noted pulmonologist with over 30 yearsâ€™ experience, fears that teaching young physicians to follow guidelines and practice protocols discourages creative medical thinking and may lead to a decrease in diagnostic and therapeutic excellence. He laments that â€œâ€Šâ€˜evidence-basedâ€™ means you are not interested in listening to anyone.â€ Another colleague, a North Phoenix orthopedist of many years, decries the â€œcookie-cutterâ€ approach mandated by protocols.
Being pressured into following a pre-determined set of protocols inhibits clinical judgment, especially when it comes to atypical problems. Some medical educators are concerned that excessive reliance on these protocols could make students less likely to recognize and deal with complicated clinical presentations that donâ€™t follow standard patterns. It is easy to standardize treatment protocols. But it is difficult to standardize patients.
A noted gastroenterologist who has practiced more than 35 years has a more cynical take on things. He believes that the increased regimentation and regularization of medicine is a prelude to the replacement of physicians by nurse practitioners and physician-assistants, and that these people will be even more likely to follow the directives proclaimed by regulatory bureaus.
Is anybody seeing these changes happen in other countries, too?
I don't think a two tier system has to be bad. If basic and preventative care is very affordable on one tier and exceptional -- like a highly experienced expert or medical specialist -- is a second tier, that's one thing. I'm talking about a difference in kind, not degree. Having to pay extra to get out of the terrible care tier is another thing. People pay through the nose to see a functional practitioner, when everyone should be using functional medicine.
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