Reflections on Impending Obamacare
Reform was surely needed to remove distortions imposed on medical care by its financing. The next big questions are what the Affordable Care Act really reforms; and, whether the result will be affordable for the whole nation. Here are some proposals, just in case.
Physicians Must Dominate Medical Computing Design. Not many people would dispute that doctors are generally smart, and for present purposes, most of them would not mind being called nerds. I started to use my first computer in 1958 when I was as good a beginner as any other beginner. For these purposes, boasting about math prowess really needs to apply to only 10% of doctors, which it probably already does. From the other 90% can be drawn the politically skillful who will be necessary to wrestle control of medical computing away from those who don't want them to have it.
The accountants who currently control hospital computing want to control the flow of medical information in order to keep the doctors from intruding into the thickets of cost-shifting and reimbursement maximization, but doctors need to be more closely involved in hospital cost accounting for exactly that reason. The main reason to keep others out of your computer is to be able to hide your mistakes. If you think that is so trivial and reprehensible that no one would stoop to it -- well, I pity you. Furthermore, it happens to be cheaper for hospitals to use doctors for data input than to design systems for reducing the clerical burdens of doctors. Cheaper in the short run, of course, because the hospital accountant cannot redesign systems of health delivery, but he can reduce his budget for data entry by shifting the cost to other departments. The accountant knows that if push comes to shove, the doctor can keep him from going home at 5 PM; his solution is to keep doctors out of his equipment. And in the dark.
Consequently, we are now spending billions of dollars on the Electronic Medical Record, and physician members of my family tell me it adds two hours to their workday without any increase in patient care. Obamacare is currently buying physician compliance by offering cash incentives to use useless systems. I speak with such passion because I attempted such a venture in 1966, and abandoned it in 1976 because of excessive data entry costs. It perversely pleases me to know of two large international corporations who have lost their shirts making the same discovery. The Electronic Medical Record is a fine idea, so long as it limits the data entry to material which is already digital. As soon as you command medical professionals to touch a keyboard, costs will soar. We have plenty of useful things to do with digital medical data, enough to keep us occupied until medical professional data entry becomes feasible, as it must. It might take five years, or it might be ten. But to hurry it up is to cost billions of more dollars, with very little to show for it.