A Plan Whose Time Has Come

Medicare Plan P, Playing The Odds

Health care reform leaders seeking a way to avoid costs have ignored an obvious option – Medicare Plan P, Playing The Odds .

In GovSpeak, that’s (PTO).

The PTO plan should be developed after a recent burst of news reports that had the medical profession telling us to please ignore what they had told us before:

·        Get a mammogram every year after 40 became Whoops! We mean after 50, and Gee Whiz! We’re not so certain that the radiation risks outweigh the benefits. Also, we know we told you to do self-exams, but now we’re telling you not to, and we’re not so sure our own Free Feelies do any good either.

·        Drugs that were said to help various conditions may either do nothing or do harm, but we’ve always prescribed them, so please take them anyway. And drugs that are proven to help some conditions never caught on, so we just don’t prescribe them. With your best interests at heart, of course.

·        Low-fat, high-fiber diets help prevent cancer – or maybe they don’t, but don’t ask which is best. But whatever we’ve told you before, please keep doing.

·        Be Aggressive in treating prostate cancer, except when you Watch And Wait, and please, don’t ask us what the difference might be.

The view from the medical profession that not so long ago thought bleeding sick people was the way to fix them and only grudgingly accepted the germ theory is that “ask your doctor” is the universal answer. That’s because, in this benign view, the doctor has kept current and knows all the answers. And of course it assumes that you can routinely get past the N.P. A. (No Patients Allowed, aka Nurse Practitioner Assistant) and see the doctor.

And maybe the doctor does know all the answers, but the problem is that recent studies have the Right Answers all over the lot and are often mutually exclusive. While the patient has a stake in finding the Right Answer, the doctor gets paid either way, which is why Medicare Plan Playing The Odds (PTO) would be such a help.

Medicare Plan P (Playing The Odds) would reimburse a doctor according to how correctly they diagnosed and treated. If a doctor was right 50 per cent of the time, those patients on Medicare Plan P would bring the doctor a Medicare payment only 50 per cent of the fees of a doctor who was completely right. If the doctor batted 100, so would that doctor’s cash register. And the ratings would be public by law.

Of course there are record-keeping issues, but those are already sort-of addressed in the current Health Reform packages before Congress. And besides, this is a certain way to still the conservative objections that Health Care ought to be left to the marketplace, not the government.

The marketplace would allow doctors who were right a higher percentage of the time to charge higher fees, while doctors who were right only occasionally would be forced to charge lower fees. God Bless Free Markets! (and occasional, regrettable deaths of lower-income types).

Those citizens whose hard work, inheritance or plain dumb luck left them with lots of money could spend it on doctors with the highest guess-right percentages, while those with less resources could get by with the less-expensive/effective doctors.

Ain’t free enterprise health reform wonderful? Tell your elected representatives you’re For PTO!

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