Friday, October 15, 2004

No Pain, No Gain

During my high school days, I ran a little track – nothing outstanding but enough to earn a letter. My coach told me that the way to get into shape was to run as long as I could, and then run another lap. That was my orientation to the physical conditioning concept of “no pain, no gain.”

The concept may have an application to health care. Years of being pampered by public adulation, professional independence, cost reimbursement, certificate-of-need protection against competition, and the like have left the health care delivery system too flabby to cope with the issues of access, cost and quality.

The pain of getting in shape goes some distance towards explaining why government is so poorly suited to leading the process of health care reform. Elected officials avoid anything that might cause their constituents discomfort. This reluctance may explain the observation by the ever insightful Emily Friedman in the September 27, 2004 issue of Modern Healthcare that health care policymakers have not only avoided the issue of healthcare inflation, “they have actually moved to preserve and even increase it.”

Politicians will be the last to annoy people by telling them that they cannot have complete freedom of choice of physician and that the physicians they choose cannot be free to practice unnecessarily expensive medicine that does not conform to best practices. More frequently they will be found promising the opposite.

Neither will they upset doctors by insisting that their practices come under institutional supervision, mainly by hospitals.

Yet all of these are fundamental to achieving the discipline and accountability that are central to health care reform.

In the market driven parts of the economy, enterprises that don’t perform don’t survive.

Maybe market competition is not the best way to reform health care, but so far nobody has come up with a better one.

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