The Tom Coburn samizdat Medicare reform proposal

Economist Tyler Cowen highlighted one of those “isn’t that obvious?” observations by physician/senator Dr. Tom Coburn (conservative R-OK)

As reported by Ezra Klein:

‘If I had the magic wand,’ he told me, ‘I’d change how we pay for Medicare.’ That’s a common enough sentiment, but the policy Coburn has in mind is a bit more radical than what’s typically offered in Washington.

‘I’d change all physicians to time instead of fee-for- service,’ he says. ‘What we’re doing with fee-for-service, and most people don’t realize this, is when you go to the doctor, they have this pressure to see X number of patients a day to meet their numbers.’

If we cut payments to doctors, Coburn says, ‘they’re going to cut the time they spend per patient. When a patient is in a room and you haven’t used your skills as a physician to really listen, you walk out and cover that absence of time by ordering tests. So if you say here’s all the hours we’ll pay for if you’re a Medicare doctor, and we can actually audit that time, doctors would have to demonstrate proof that they’re spending this time with patients.’

That wasn’t, I noted to Coburn, a policy that appeared in any of the bills he had sponsored, a fact he acknowledged with a laugh. ‘I didn’t put that in there,’ he said, admitting the idea has little political support. ‘It’s just something I’ve thought about a long time. Nobody should be seen for less than 20 or 30 minutes if you’re doing this properly. And if I knew I was going to get paid for my time I wouldn’t be in a hurry to see the next patient.’

Here are further ideas on Medicare reform.

Fee-for-service cannot be the basis for any sort of optimal medical system. Most of the managed-care organizations that have emerged have compensation based first on salary, secondly on performance (results). Measuring results is extremely tricky, not least because of physician patient-selection bias. But I think it can be done (it’s just math and sufficient data).

What do you think? (first time comments are moderated)

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s