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Subject: qotd: Bill Keller on P4P and single payer
Date: Mon, 28 Jan 2013 11:28:03 -0800
From: Don McCanne <email@example.com>
To: Quote-of-the-Day <firstname.lastname@example.org>
The New York Times
January 27, 2013
Carrots for Doctors
By Bill Keller
With its ambitious proposal to pay doctors in public hospitals based on
the quality of their work — not the number of tests they order, pills
they prescribe or procedures they perform — New York City has hopped
aboard the biggest bandwagon in health care. Pay for performance, or P4P
in the jargon, is embraced by right and left. It has long been the
favorite egghead prescription for our absurdly overpriced,
underperforming health care system. The logic seems unassailable: Reward
quality, and you will get quality. Stop rewarding waste, and you will
get less waste. QED! P4P!
If only it worked.
For if you spend a little time with the P4P skeptics — a data-bearing
minority among physicians and health economists — you will come away
full of doubts. In practice, pay for performance does little to improve
outcomes or to control costs.
The first problem with P4P is that it does not address the biggest
problem. Americans spend more than twice as much per capita as other
developed countries on health care — a crippling 18 percent of the
country's economic output, and growing.
But the main reason everything costs less in other countries is that
other countries tend to have one big payer — usually the government —
with the clout to bargain down prices. A single-payer system has, so
far, proven politically unpalatable in this country.
Comment: Bill Keller, the former executive editor of The New York
Times, explains why pay-for-performance (P4P) is a false solution to the
problems of high health care costs and mediocre quality. Although he
recognizes the correct solution - a single payer system - he follows the
lead of other journalists and politicians in immediately dismissing it
as being "politically unpalatable."
Was Medicare politically unpalatable?
Consider the following oft-expressed concept. "Single payer is the
solution that would bring health care to everyone at a cost that we can
afford; therefore we shouldn't adopt it because of concerns about
political feasibility." Phrased this way, obviously this is a non sequitur.
Let's jam single payer into its proper place in government. The we'll
see how politically unpalatable it is, or rather is not.