Tuesday, November 3, 2009

Hsieh LTE in WSJ on Bad Incentives in Massachusetts

The November 2, 2009 Wall Street Journal published my LTE replying to their October 14, 2009 story on the proposed Massachusetts health care "global payment" system.

Here's my LTE:
The Incentives Aren't to Help You

The proposed Massachusetts "global payment" system creates a tremendous incentive for physicians and hospitals to render as little care as possible ("Your Massachusetts Future," Review & Outlook, Oct. 14). If your care costs less than the annual allotment, then they keep the unused amount. 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.

Suppose the state has already used up 85% of your annual allotment. You then see your doctor for a severe headache. He examines you and says, "No, you don't need a $1,000 MRI scan of your brain. Why don't you take two Tylenol and call me in the morning."

Would you be 100% sure that he's giving you unbiased medical advice?

And even if your doctor continues to conscientiously practice in your best interest, he must constantly battle hospital administrators seeking to reduce spending on your care.

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 it is doing. A government big enough to "guarantee" you health care will also be big enough to limit it.

Paul Hsieh, M.D.
Sedalia, Colo.
(I eventually argued a similar point in the longer PajamasMedia piece which also came out yesterday.)