A Prediction On Capitation

There are many possible ways to pay doctors. If for some bizarre reason I wanted health care reform to fail after enacted I would choose capitation. This is the way most likely to screw both physicians and patients and make everyone want to abandon the system. We’ve already seen that mistake under HMO’s, and we know how most people feel about them. While there is certainly a problem with doctors being motivated to  perform more expensive care with payment by fee for service, capitation provides motivation to do as little as possible as doctors are paid a flat mouthy amount regardless of what they do. We really don’t have a problem with too much being done in health care in this country overall. The problem is that some people receive more expensive services than needed while millions don’t receive the health care they need. What is needed is to reform the system so that care is available for all, which will keep doctors so busy providing necessary care that we should not need incentives not to work as occurs under capitation.

I’ve found it disturbing that many bloggers who are supporting health care reform are also naive supporters of capitation. Undoubtedly most of them are too young to require very much medical care and have never experienced the problems under capitation. There is a tremendous difference between reading and blogging about health care and actually having experience in the field (as is seen with the misconceptions among many liberal bloggers over care from the VA). At least I felt a little better after reading this post from Ezra Klein. Ezra supports capitation but I was happy to see he concluded by writing, “I’m actually a big fan of this model, but I rather doubt it will be adopted here.” In this case I hope that his ability to predict political outcomes is superior to his understanding of health care in the real world as opposed to theoretical blogging.

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