Rational healthcare, not rationing
The Affordable Care Act remains in Republican cross hairs and very much in the news. In recent days, several patients have asked me what the law will mean for them. Many of the people I care for are incurably ill and need expensive medical care to stay alive. They've heard politicians say "Obamacare" will take away their choices, rob them of hope for living longer and cast their fate to "death panels" of faceless bureaucrats. Fortunately, none of this is true.
As a palliative care physician, I was relieved by the Supreme Court's ruling and hope Congress allows the law to stand. This is not a partisan reaction. Diseases know no politics. I'm relieved because this law may well unravel patterns of payment and practice that promote irrational care and make dying much harder than it has to be.
Today, most doctors are salaried employees and healthcare is a complex industry. Yet we still pay physicians for the quantity of procedures they perform rather than the quality of care and results they provide. Our system is specialist-centered rather than patient-centered. And anyone who has watched a loved one die badly will tell you that sometimes specialists do too much.
Our current structure for financing and delivering medical treatment developed in the decades after World War II, when doctors' offices were the engines of the healthcare system. Doctors were paid for services: an office visit, house call, setting a broken bone, performing an appendectomy or tonsillectomy. The busier doctors were, because of demand or reputation, the more money they made.
http://www.latimes.com/news/opinion/commentary/la-oe-byock-palliative-care-aca-20120718,0,467862.story
