Herb Kunkle, MD writes in:
The addiction to middlemen and conscription to the Fourth Branch of Govt and regulatory bodies probably began ~ 1929 when the first insurance company, covering Dallas/Ft Worth teachers was formed.
50 cents every other paycheck, only for catastrophic care, a simpler time.
-1944- With salaries and other benefits frozen during WWII, businesses start offering HC ins to retain/recruit employees.
-1965- Medicare/Medicaid/Govt begins to insert itself as you describe. HC costs, at that time 3-4% of GNP begin to soar. Approaching 20% today, and as E Bowles says- ‘The vapor that is driving our economy into the abyss.’
-Insurers, till that point, primarily covering catastrophic care and big ticket items follow suit and begin to cover every iteration, every new RX, even those c questionable value. I guess this was beginning of the ‘War on Women’.
If a Rx isn’t covered, even if questionable, one is sexist, racist, chronologically or bariatrically biased. A terrorist.
-1970’s on- HMOs, DRGs, P4P, RVUs, the acronyms du jour, c attendant ppwk, regs, mandates. Some c short term savings, almost all which fail, but increase the bureaucracy and middlemen infecting the patient-physician relationship.
-And thru these times an increasing entitlement nation. Social engineers A dysfunctional and feckless Congress.
-Oh, and one more thing, a bunch of Whacko kooks, most no longer practicing physicians, begin mtg behind closed doors in late 70’s/early 80’s. Dvlp Recert, then MOC to further control our profession, keep us running faster and faster in the hamster wheel, c no added value, significant risk if one doesn’t comply. The cabal surrounds themselves c the usual Mandarins and sycophants. And the busy practicing docs, compliant, risk adverse, and c a million excuses and qualifiers, just as they did little to understand the consequences of above items c no proactive moves, accept MOC and its attendant useless crap. We circle the wagons and shoot in. What a crew.
So, the old adage-‘When you don’t know where you’re going, any road looks good’ rings true in HC.
Understanding above, and the many groups c perverse incentives who add little value to what we do allows
for productive discussions and beginning solutions to the mess HC/Medicine has become.
Look fwd to committed folks joining the discussions c ideas and actions to Right the Ship. First we abolish MOC.
Have a great weekend. Fight the Power. Merry Christmas, Happy Hanukkah. Peace.
-Mother Emauel (I’m sure you’re proud of your son but he’s a Kook. And never passed his Boards. Not even once.)
-Nancy Pelosi (Please read next Bill you pass. Legislative malpractice not to do such).
-All the rest of the theorists, Academics, social engineers, Ivory tower types who think they know HC and what’s right for us.