IronWerx's Artden's Friends

The Pool of Incentive
This is my health care post, not my post alluding to old SSI games for the Apple ][.

The United States health care system succeeds by creating a vast pool of incentive called money. It does this by prepaying for health care with mostly tax-free dollars as well as subsidizing health care with other taxes.

This pool of incentive is so vast that the excess slop from it is used to cover the indigent who are served by a variety of government programs such as Medicare. On average these programs only cover 80% of costs, so doctors and hospitals have to overcharge paying/by-insurance customers just to break even. (Or engage in fraud, overbilling the government programs for things that didn't happen.)

Some people seek their part of that pool of incentive by creating innovative new products, medical technologies, medical procedures, and miracle drugs.

Some people seek their part of that pool by suing doctors, with purpose or without.

Some people seek their part of that pool by being middlemen of one stripe or another. By isolating one part of the whole medical service chain, and then hoping to do it better, faster, for less money. If you read 'The Mythical Man Month' it makes the point that some jobs, like software design and also health care, are not like digging a ditch. If one man can dig a ditch in a month, then two men can pretty much dig a ditch in half a month. But two doctors cannot necessarily fix a patient in half the time. The model of work in health care is one or two high end practitioners, a number of highly trained support troops around him or them, and a lesser cadre of minimally trained people around them who remove obstacles and handle management tasks. It is those management tasks which can theoretically be managed, batch-jobbed, fobbed out. Sometimes it works and sometimes it doesn't, and customer service usually goes by the wayside.

A national health care plan of the kind currently up for discussion will drastically reduce that pool of incentive. On the good side, we will have fewer lawyers suing doctors for big payouts. On the bad side, we will have less excess slop to cover the indigent. We will have fewer if any new products, technologies, methods, or drugs. And as much customer service as possible will be fobbed out to large companies who do it as cheaply as possible and give therefore, almost no customer service whatsoever.

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