Controlling Massachusetts' soaring medical costs, many health care leaders believe, may require residents to give up their nearly unlimited freedom to go to any hospital and specialist they want.
..."You can't reap these savings without limiting patients' choices in some way," said Paul Levy, chief executive of Beth Israel Deaconess Medical Center.
...A state commission recommended in July that insurers largely scrap the current fee-for-service system -- in which insurers pay doctors, hospitals, and other providers a negotiated fee for each procedure and visit -- and instead pay providers a per-patient annual fee to cover all of the patient's medical care.
This new system of "global payments" would discourage overuse of expensive medical services, force providers to live within a budget, and improve coordination of care for patients, supporters argue.
What the supporters don't mention is that it also creates a tremendous incentive for physicians and hospitals to render as little care as possible. Under the Massachusetts proposal, if your care costs less than the annual allotment, then they keep the unused portion. If your care costs more, then the difference comes out of the providers' pockets. Such a system thus pits your doctor's interests against your own.
For the sake of argument, suppose your annual allotment is $5000 and you've already spent $4500 for that year. Now you go to your doctor's office complaining of a severe headache. He examines you and says, "No, Bill, you don't need a $1000 MRI scan of your brain. Just take two Tylenol and call me in the morning".
Will you be 100% sure that he's giving you unbiased medical advice?
And even if your doctor consistently and conscientiously acts for his patients' best interests, he will inevitably find himself at odds with hospital administrators questioning whether this or that expenditure is appropriate:
"Does Mr. Jones really need another ultrasound test? Is there a cheaper antibiotic you could use? Isn't his heart rhythm stable enough to allow moving him down to a regular hospital bed, rather than spending another night in an expensive ICU bed?"
Do you want your doctor constantly looking over his shoulder trying to balance your needs vs. the demands of a hospital administrator who might be deciding whether or not to renew his practice privileges?
It is precisely this potential conflict-of-interest that caused patients in the 1980s to reject the similar "capitated" payment systems of HMO's (Health Maintenance Organizations). The 2009 Massachusetts proposals may carry a new name, but the basic principle is the same.
Advocates of government-run health care like to claim that it is morally superior because it "doesn't put a price on human life".
But when the government sets an annual spending cap for each patient, then that's exactly what they're doing. In that case, you had better hope that your life is still worth enough to your government...