Health insurance bill passes the house

[DGuller]

Why would physicians put up with historically "low H score yielders"? (whoever they may be, but likely the poor and minorities)

There could be a benchmark in expected costs for each patient for each year, adjusted by their H score.  If you have a bunch of crappy patients, you'll be expected to spend more on them each year.  The point of the score is to adjust for the different levels of health or potentially problematic conditions when the patient is first assigned to the primary care physician.

[Berkut]

Why would physicians put up with historically "low H score yielders"? (whoever they may be, but likely the poor and minorities)

There could be a benchmark in expected costs for each patient for each year, adjusted by their H score.  If you have a bunch of crappy patients, you'll be expected to spend more on them each year.  The point of the score is to adjust for the different levels of health or potentially problematic conditions when the patient is first assigned to the primary care physician.

Wow, what a nightmare of a system. You don't think that is going to be just ridiculously abused and gamed?

Why won't people just try to get as low a score as possible, so they can justify as much healthcare as they can?

[DGuller]

Wow, what a nightmare of a system. You don't think that is going to be just ridiculously abused and gamed?

Why won't people just try to get as low a score as possible, so they can justify as much healthcare as they can?

Any incentive system can be gamed or abused, and the higher the incentives, the higher the potential for abuse.  Unfortunately, we kind of need incentives to avoid situations where there are no incentives.  A well-designed score would be hard to manipulate down, however, short of inflicting permanent disabilities upon yourself (and you'll get no direct benefit from it anyway).  I don't think people want to see doctors that badly.

[Maximus]

Wow, what a nightmare of a system. You don't think that is going to be just ridiculously abused and gamed?

Why won't people just try to get as low a score as possible, so they can justify as much healthcare as they can?

People will be transplanting cancer into their bodies just to get all that sweet sweet chemotherapy.

Seriously, do you listen to yourself?

[Berkut]

Wow, what a nightmare of a system. You don't think that is going to be just ridiculously abused and gamed?

Why won't people just try to get as low a score as possible, so they can justify as much healthcare as they can?

People will be transplanting cancer into their bodies just to get all that sweet sweet chemotherapy.

Seriously, do you listen to yourself?

I love it when people are outraged at the comments they make for others.

[Maximus]

Explain, if you will, what incentive there could be to get "as low a score as possible".

[Maximus]

I love it when people are outraged at the comments they make for others.

I love it when people make up outrage in order to get defensive.

[Eddie Teach]

The incentive would be for the doctors to massage the numbers in whichever direction gave them the best payout.

[Berkut]

Unless I do not understand it, DGs plan involves a patient having some kind of health score, and the lower it is, the more care the doctor should lavish on them, and the more care the doctor is "allowed" in some fashion, to give them. This, btw, is absolutely health care rationing.

That means that both the patient and the doctor will be incented to give the patient as low a score as possible, so there will be less difficulty in obtaining care in the future, should it be necessary. And if care is not necessary, great, the doc gets a higher efficiency rating. I can easily imagine a lot of chronic illnesses of the mild sort being diagnosed for example. More generally, the point is that any kind of rating system like this is going to be a mess. There is no way the government is going to come up with any kind of sophisticated system that will not have incredible unintended adverse incentives.

Notice nowhere in there is anyone injecting any cancer, but I am sure that is what I really mean.

[Berkut]

The incentive would be for the doctors to massage the numbers in whichever direction gave them the best payout.

WHY DO YOU WANT PEOPLE TO INJECT THEMSELVES WITH AIDS YOU BASTARD!!!!

[DGuller]

The incentive would be for the doctors to massage the numbers in whichever direction gave them the best payout.

Possibly.  Making sure that the score would be completely independent of the assessment of the interested parties is impractical.  However, compare the incentive to massage the scores to the incentive to order a bunch of expensive meaningless tests, to get a cut directly into your pocket.

[garbon]

Explain, if you will, what incentive there could be to get "as low a score as possible".

Easy.  Let's say I have rheumatoid arthritis and I think it is quite severe, however, my physician thinks it is a mild case and thus will only put me on simple palliative drugs (like anti-inflammatories).  I know that there are big expensive medications out there that I think would completely get rid of my pain but I don't have access to them as I can't afford them on my own and my physician isn't willing to prescribe them.  If I could somehow manage to get myself a lower score (perhaps reassessed by someone else with less scruples), I might get those expensive drugs as the doctor would be motivated to spend what was necessary to get my failing health score up.

[Berkut]

I love it when people are outraged at the comments they make for others.

I love it when people make up outrage in order to get defensive.

Mocking your rather sad strawman is not being defensive. It is just mocking.

[Berkut]

The incentive would be for the doctors to massage the numbers in whichever direction gave them the best payout.

Possibly.  Making sure that the score would be completely independent of the assessment of the interested parties is impractical.  However, compare the incentive to massage the scores to the incentive to order a bunch of expensive meaningless tests, to get a cut directly into your pocket.

True enough - no doubt that there are currently plenty of crappy incentives in the current system.

But much of that is because the person paying for the expensive tests is totally removed from the people actually getting and ordering the tests.

[Maximus]

Mocking your rather sad strawman is not being defensive. It is just mocking.

Beginning a rebuttal with a smiley is a particularly pathetic form of defensiveness.