I'd imagine some of the lowest hanging fruit on the healthcare reform tree would be Bush's blatant give-away to drug companies with the Medicare drug program. A clear-eyed revision of that program should make the nation's balance sheet look a lot better.

Healthcare has to be on the frontburner as it is the biggest problem whose solution will contribute to long-term economic recovery. The stimulus is stop-gap. Healthcare reform, plus developing alternative energy and other innovative domestic industries, will put us on the road to recovery.

From the WaPo article:

"Making policy changes in those programs -- such as...paying doctors for results rather than procedures -- could improve care while generating long-term savings, experts say."

The potential cost savings are obvious but for whom would care be improved? If physicians are to be rewarded for results, then wouldn't they have an incentive to not treat critically ill patients?

jm, I could be mistaken, but would expect that they mean to pay based on condition being treated (i.e. compound fracture has a set price for entire treatment rather than itemizing emergency room fees, x-rays, doctor's treatment, cast, etc.)

The details would be important, you don't want hospitals cutting too many corners, but this would have advantages of:

a) reducing paperwork
b) encouraging hospitals to avoid unnecessary tests and procedures.

b) encouraging hospitals to avoid unnecessary tests and procedures. -- tanstaafl, @ 15:34

The hospitals have bought the machinery, have made contracts with labs and, by golly, they're gonna use them, to get their money back! Not to mention to cover their butts in case of lawsuits.

In early Dec of '07, I had a bellyache. Since it didn't quit, after 48hrs, I went off to the doctor (GP). He poked and he prodded and he said: "Appendicitis; better operate right away, before it ruptures".

Off I go to the emergency room (where the surgeon was, patching up the victims of a pile-up). Tests galore, some like from a SciFi film, from 10AM till 17:00 (partly because I had to be fitted in between the victims of the pile-up) and, with each one, comes the cheerful: "A-yup; sure looks like appendicitis".

Had the op at 19:30, out of the hospital at 9AM next morning. Two days later, I go to the sugeon's office for a check-up. "We did a biopsy" he says, "and it sure was appendicitis". He looked puzzled, when I started laughing hysterically and couldn't stop. Finally, eyes streaming, I managed to ask: "What would you have done if the biopsy showed it *hadn't* been appendicitis? Would you have sewn the appendix back in?". "But we knew it was appendicitis", says he "all the tests indicated it." "So, what did you do the biopsy for?" Silence.

jm, I had the same question. I'm not sure how to get around it. Since Medicare patients are, by definition, elderly, they are at risk of not improving no matter what you do. Some doctors would tend to not put in the effort if they didn't think that the patient would improve. Also, if improvement is measured against some standard that says the doctor has to do better than the average, that will mean that approximately half the doctors don't get paid no matter how well they do.