PHIMG Coalition - Grassroot voices demanding Medicare For All!

Well-known health care analyst Alain Enthoven had an op-ed in the Times yesterday with his solution to the health care spending crisis. It's a bizarre combination of market and nonmarket measures.

On the one hand, he points to the virtues of large, multispecialty physician practices "in which doctors work together to improve quality and keep costs low. Their doctors share values and cultures of teamwork. They keep comprehensive electronic medical records, they share information, and they emphasize disease prevention and chronic disease management as a matter of course. These doctors are usually paid salaries, not fees for services. Research and experience suggests that these practices — which exist in all regions of the country, including both rural and urban communities — can reduce costs by 30 percent." In other words, within the practice these doctors rely not on market mechanisms (i.e. price and competition with each other) but on cooperation to cut costs and improve care.

On the other hand, he wants to shift patients toward such practices by increasing competition, i.e. by creating incentives that will force patients, their employers and their insurers into such practices.

Medicare and the VA have already shown the economies of scale, and the potential for teamwork, in large, integrated healthcare institutions. The evidence is there for making such models universal. Trying to do it through competition will just maintain the fragmentation among providers and insurers, which will force them to continue wasting money on competing with each other.

- Andrew Pollack