Disclaimer – the Annals of Internal Medicine is an ACP publication and I am on the ACP Board of Regents
Yesterday, the Annals published online 3 articles about health care reform. They have started a discussion forum and asked me to comment. I highly recommend reading the articles and joining the discussion – Health Care Reform.
While I have a conflict of interest, my comments are independent. My commentary starts as:
These perspectives make interesting reading, however, they read as committee reports. I fear that none of the "solutions" recognize a particular fundamental problem in our payment system – the formula for paying physicians. We receive pay for "widgets." Each type of widget has a specific payment based on a billing code. Once we get paid for widgets, we have an incentive to do more widgets (or at least more expensive widgets.) Thus, we have an incentive structure to do more, not to do appropriate. A few examples might help.
When I have more time, I will expand my comments. Let me know what you think.
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