“Medicine Can’t Be Subject To
Cost Accounting”
Why are doctors singled out
as the bad guys in the high cost at Black Rock saga? Why all the sniping at the medical profession
regarding health costs? Because, say the
social scientists, it is the doctor who makes the decisions that cost money to
implement.
In other words, they want
to brow beat the doctors into ordering fewer EKG’s, ration x-rays and limit
laboratory testing. They want the doctor
to be sure of his diagnosis before he orders confirmatory tests. That is silly, of course, because if the
doctor is sure of the diagnosis, then no tests at all are indicated. The purpose of tests is to help make a
diagnosis. And indeed, the laboratory
and radiology departments contribute invaluable information in the care of the
sick.
Another throw-off from
testing is that the doctor becomes more educated and experienced in his
practice. To ask the physicians to limit
their diagnostic procedures would be like asking a great quarterback to limit his
plays, or Joe Louis to eliminate the left jab.
It just doesn’t make
sense. If each doctor cannot practice
according to his conscience, then the profession is destroyed.
It is true, however, that
the decision making by the doctor is responsible for health costs, or rather,
medical care costs. If the doctor orders
tests, it costs money; and if the doctor sends patients to the hospital, it
costs money. Who but the doctor can make
such decisions? To blame the cost of
medical care on the doctor is redundant.
It is simply another way of saying that the doctor is taking care of his
patient.
Thus to blame the doctor
for the cost of medical care is tantamount to blaming the patient, John Q.
Citizen, for getting sick in the first place.
If the fool didn’t get sick, then we wouldn’t need doctors or hospitals
at all.
The above sounds ludicrous,
but is must be taken seriously. It is
quite a serious matter when an upstart profession of social scientists, after
“studying” the venerable profession of medicine, announces a major discovery,
the fact that doctor’s decisions cost money.
The inference being that fewer decisions by doctors would cost
less. And carried to the absurd, that no
decisions at all, and letting nature take its cost, would cost nothing – but
lives.
The practice of medicine is
not a mechanical or business venture that can be subjected to cost
accounting. It is a science, and also an
art. It really cannot be run efficiently,
and still work at optimum effectiveness.
The inefficiency and waste in the practice of medicine is truly in
behalf of the patient. Schemes that will
provide monetary incentives for the doctor to practice more efficiently will,
if successfully implemented, merely swap money for lives.
The problem of
disseminating quality medical care is, by definition, expensive. I do not know the best way, but the nation
with its numerous lobbies and pressure groups, is probing towards a solution to
the problem. It may well turn out to be
a mix of private practice, government subsidy, and co-insurance plans by
medical groups. By this multi-faceted approach, we might avoid the problems
inherent in any single system of medical care.
Such a pluralistic system might dilute the risks and amplify the
benefits of each component. The only
danger is that, before the nations arrives at its own consensus, the
administration and the Congress might impose a system in the name of the
people.