Word: carefuls
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...smart, conservative, data-driven, patient-focused medicine is not necessarily profitable medicine. Last year, Mayo lost $840 million on $1.7 billion in Medicare work. It compensated by charging private insurers a premium for the Mayo name, but they're starting to balk. "The system pays more money for worse care," says Mayo CEO Denis Cortese. "If it doesn't start paying for value instead of volume, it will destroy the culture of the organizations with the best care. We might have to start doing more procedures just to stay in business...
...Change He Seeks? In the coming weeks, millions of dollars will be spent on the health-care debate because trillions of dollars are at stake. Lobbyists are already warning that Obamacare will empower bureaucrats to reject new drugs and procedures on the basis of shadowy cost-effectiveness formulas that place a monetary value on life. Ads will soon transform the seemingly innocuous push for comparative research into a nightmarish vision of Big Government telling doctors what to do, suppressing the development of lifesaving technologies, ignoring the needs of minorities in pursuit of one-size-fits-all "cookbook medicine," destroying...
...Helping organize the pushback against the drive for data has been former House whip and legendary Democratic operator Tony Coelho, an epileptic who helped write the Americans with Disabilities Act and now leads the Partnership to Improve Patient Care. The partnership is an odd coalition of the drug companies, devicemakers and medical specialists who stand to lose the most from evidence-based medicine, joined by a variety of patient groups (some of whom also receive industry funding) concerned about access to care. Coelho says he welcomes effectiveness research if it can help doctors and patients make more informed decisions...
...Orszag says. It is fair for industry groups to insist on an independent agency to oversee the effectiveness research, so that decisions about what to study are separate from decisions about what to reimburse. And some of Obama's quality incentives are fairly straightforward, like extra dollars for primary care, prevention and computerization; to discourage wasteful defensive medicine, he seems willing to limit malpractice lawsuits when doctors stick to best practices. But ultimately, rewarding quality rather than quantity will require daunting changes in Medicare reimbursement policies. That could mean lower patient costs and higher provider revenues for proven treatments...
...This would probably qualify as "rationing," but anyone who's ever had an insurer refuse to pay for something knows that health care is already rationed, in the sense that you can't always get everything you want. Still, oxen would be gored, and the backlash could be nasty. The ultimate success of Obamacare might depend on a cultural change among doctors and patients, a national realization that more care isn't better care. "We've got this ethos that the best doctors do everything under the sun and rule out every zebra," Emanuel says. "And hey, they get paid...