Sunday, February 17, 2013

Fee For Service Medicine

I happen to like a concept called "fee for service medicine."

In fee for service medicine, a patient will have a direct contract with a doctor to perform a medical service.

Many people believe that fee for service medicine is immoral. Their argument starts with the statement that medicine is a higher calling and that doctors should not be constrained by an obligation to an individual patient but are, in fact, operating at a higher level in which they are performing a service to humanity.

With insurance, the doctor has a contract with an insurance company and is administering care to members of the pool. Members of the GOP believe that health care should be provided by a system in which doctors have contracts with employer based pools. The left believes such a system is inequitable and want a state owned pool.

The primary health care debate starts with the assumption that medicine is a higher calling and doctors should not be restricted by obligations to individual patients. The issue is who owns the pool. Should the pools be owned by billionaires or should the pools be owned by the state.

I admit. I am standing way out in left field waving my arms saying. "You know. Just maybe we should discuss the idea of fee for service medicine."

I realize that my radical stance (that health care could be delivered on a contractual basis between a care provider and a patient). I realize the radical notion that doctors have obligations to individual patients is in direct conflict with the progressive notion that medicine is a higher calling and doctors administer care to groups not people.

I realize that my idea of a doctor providing a service to a patient is radical beyond belief and is completely outside the health care debate. But, I have a subtle argument that says a collective is actually a group of individuals, and that if doctors worked on a fee-for-service basis providing care with direct contractual obligations to patients that we would create a world with healthier individuals. Healthier individuals means a healthier group.

I understand completely that many doctors today scoff at the idea that they should have any sort of direct contractual or moral obligations to patients. But, guess what, there just may be some doctors in this world who do believe that they are providing services to individual people, and that they should be able to form contracts to provide care to patients on a fee-for-service basis.

I am standing out here in left field watching republicans argue that the pools should be owned by billionaires while the left want the pools owned by the state. I believe this to be a false dichotomy, and I just want a group to entertain (even for just a moment) the radical notion that doctors provide services to patients.

I know the idea would be rejected by both the GOP and by Progressive, but I think the debate would be fun in and of itself.

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