I wish I had a million dollars that I could use to convince my patients to stop smoking.
I wish I had a million dollars to get my patients to take their medicines.
I wish I had a million dollars to get people to shape up and lose weight.
I wish I had a million dollars to make sure people just listened to me so they would always wear their seatbelts and never use their cell phones while driving.
Heck, I just wish I had a million dollars myself.
But I don't.
That's because I'm a doctor: I don't offer people a million dollars to take my advice. I especially don't dangle the prospect of them earning that money if they follow my "non-medical" advice as I pose as one who gives medical "information" either. Nor do I pretend to think that I will change peoples' behavior with money.
But there are those who believe in the Keynesian economics of health care delivery where, if we just throw a bunch of money at these problems, they're all going to go away; that they're going to make a difference in millions of peoples' lives as they watch TV. Unfortunately, this theory of economics hasn't worked out so well for our economy and I really don't see why we should think this type of thinking should work so well for health care. Can we really change behavior of weight gain without changing the psychology and sociology of the home?
But there will always be ideologues in the world of marketing who believe in the power of Keynesian economics. After all, the money's not theirs; marketers get their dollars from advertisers. That way, like Oprah, they can offer a million dollars to promote, entice, market, and maybe even deceive - especially when they only give their million to a person the marketer chooses as their "winner" because they've followed their self-imposed health rules that follow a pre-ordained rubric.
Marketers have use this approach for years with things like The Price is Right, Jeopardy, and (my favorite) The Wheel of Fortune! We absolutely love this stuff. Like bugs to a light, we are drawn to the easy money that isn't.
But when it comes to health care, I just hope we really think about what we're getting for someone else's million.
-Wes
When I read your first sentence, I thought good luck with that, the government has thrown away countless millions trying to convince people to stop smoking. When I was getting radiation treatments, there was a man who was there at the same time everyday. He was getting radiation for lung cancer. As soon as his treatment was over, he would go outside, remove his oxygen and smoke a cigarette. Nothing was going to convince him that it was worth it to quit. That's the issue, really. People don't change their habits until the become convinced beyond a doubt that it is worth it to them.
ReplyDeleteC'mon Wes, emmy-
ReplyDeleteAre you saying Goverment $$ never works? My guess is that your mothers smoked Lucky Strikes and drank Wild Turkey throughout their pregnancies with you two. (Wes-maybe that explains why you're stuck inserting late nite pacermakers instead of rolling in the cash as a Fortune 500 CEO). The government led campaign to stigmatize drinking or smoking during pregnancy HAS worked.
Anony-
ReplyDeletePlease check the links I provided in the piece. We're talking about the Dr. Oz show's offer of 1 million dollars to a person of the show's chosing who follows their program for weight loss and life style change, not a government program.
Anonymous said, "The government led campaign ... HAS worked."
ReplyDeleteIt has likely worked in the same fashion that the Stimulus bills have. Jobs were created, but at what cost? $200,000-4.5 million per job! If you divide the number of those who quit drinking into the millions spent, how much was spent per quitter? But you will say, "If only one quit, that is justification!" If Warren Buffet was spending his own money on a program like this, he could feel vindicated if he saved only one. It's his money. What was spent on the programs you mentioned was TAXPAYER MONEY! The money could have and would have been spent more wisely in a private health enterprise!
Dr. Oz' offer was only possible because he has private enterprise sponsors who could afford $1 million. It sure didn't come out of his pocket!
Tim-
ReplyDeleteSurely you must know that gov't sponsored preventative public health expenditures have been enormously successful. Perhaps you would have rather waited for private enterprise to VOLUNTARILY stop polluting the air and water; for drug companies to VOLUNTARILY produce minimal profit, high liability vaccines without govt subsidies and liability protection. Sure the current political climate is dysfunctional, but this too shall pass.
Anonymous said, "gov't sponsored preventative public health expenditures have been enormously successful."
ReplyDeleteI would certainly like to see the numbers that support your opinion. What has been prevented and how many times? For the millions spent, how much did it cost for the very few who really avoided a health problem? If the government advocates for a particular healthy lifestyle, who knows if they're right. Take the Food Pyramid. How many times has the government recommendations for a healthy diet changed. Government endorses "best practices" within Medicare for certain diseases. Under Obamacare, payment and grading of physicians by their adherence to these "best practices" will be enforced. The problem: some of these have been found to be WRONG!
Yes, I trust the government to spend dollars according the which way the political wind blows, reacting in knee-jerk fashion to the emotion of the day, and trying to tell me how to treat the patient!
Patients need to be protected from the these MPH/MPP geeks who are more accountants than doctors, but who are dictating health care policy.
REAL doctors who see patients daily are the patients advocates. NOT the government geeks! We are the ones in the best position to know what each individual patient needs. NOT the government geeks!
Tim-
ReplyDeleteAs long as we get paid for providing services to our pts whether we need them or not, I doubt we can ever be true pt advocates, As your Republican friends always say, "it's all about incentives. " The more unnecessary ICDs Dr Wes inserts, the more he gets paid. Ditto for the hospital. The incentives are all to do more. We physicians have proven that we arent capable of being true pt advocates. Today it's the insurance companies who make the rules, tomorrow the government geeks take a turn.When it finally gets full circle back to us, maybe we wont screw it up
Anonymous said, " The more unnecessary ICDs Dr Wes inserts, the more he gets paid."
ReplyDeleteYou know, I'll bet Dr. Wes is like me, and I hope most physicians are. The more we fit the treatment to the patient's actual needs, the more satisfying our practice is to us. I could turn almost any skin cancer removal from a complex closure into a local flap reconstruction, just by doing a little more surgery than the patient needs, but getting more reimbursement. I, however, don't feel that that was what I signed up for or was trained to do. I have to spend too much time fighting to get patients the treatment they need to be trying to game the system. I have been practicing for almost 30 years and can say with all honesty that I have never operated on a patient that it wasn't appropriate for by anyone's criteria. I have, on the other hand talked many a patient out of an operation that they did not need. If I had treated medicine more like a business than a profession, I might have more money, but I would have violated that little oath that some seem to forget.