Brilliant health care idea: replacing fee-for-service with fee-for-no-service
February 25, 2013 7 Comments
Richard Thaler writes on health care, advocating among other things:
A fee for health rather than fee for service model. Doctors and hospitals should be paid for keeping their patients well. Paying them for doing more tests and surgeries creates bad incentives.
When Thaler plays chess, does he think even one move ahead? I am sure that my readers do not need me to tell them how doctors would respond to a “fee for health” incentive system, do I?
Heh. Quick doctors/hospitals, who wants to get to administer time-consuming experimental or at least palliative care to this incurably-diseased patient on a ‘fee for health’ basis? Don’t all raise your hands at once. Meanwhile, I sense some good business opportunities for PR and advertising firms offering services to doctors helping them sign up a bunch of ‘healthy’ patients that they can almost-never-see but regularly bill for…’Dear Health Ins. Co.: I kept this 19-year-old athletic male healthy again this week. No visits/tests/treatments. Send me $370 please!’
But seriously, this raises the question: what would ‘fee for health’ even mean? Someone appears to have forgotten that actual healthy people mostly aren’t even seeing a doctor, for anything, in the first place. That’s part of the definition of ‘healthy’. Isn’t it? It’s sort of like saying supermarkets should be able to bill…(someone?)…for the length of time that…(some group of people?)…doesn’t need food. Say what?
In any event, Obamacare will basically be a fee-for-health model anyway: if you’re healthy enough that you’re drawing breath, you pay. Whether you need health care or not. The way out of paying is to lose your health enough that you die. The rest is just accounting and administration, and so the distinction between that and ‘fee for health model’ is a distinction without a difference. So rest easy, Richard Thaler, you’ve gotten your wish.