But the dialogue between himself and a physician who posted commentary after the article is great fun...sharing with you, here:
- Van Gross, MD
- Miami, FL
People did not enter medicine to become Uwe Reinhardt chess pieces. If someone had asked the late great Stan Musial if he would have liked certain "recommendations" if not constraints placed on him so he could have better outcomes, he would have taken a left handed swat at said individual and tatooed his health care challenged body into the right field bleachers.
I know the analogy is imperfect but so is medical care. As a result, Reinhardt style comparisons of plans falls apart when individual variations for any given disease are acknowledged which prevent draconian pronouncements re: optimal care strategies for many different patients with diverse co-morbidities and cultural exigencies. Next year is 2014, not Huxley's 1984. If the idea is to begin the roll out of an army of "pawn medics" marching to the dictates of King Reinhardt, let the Medicare Advantage drum beat begin.
I know the analogy is imperfect but so is medical care. As a result, Reinhardt style comparisons of plans falls apart when individual variations for any given disease are acknowledged which prevent draconian pronouncements re: optimal care strategies for many different patients with diverse co-morbidities and cultural exigencies. Next year is 2014, not Huxley's 1984. If the idea is to begin the roll out of an army of "pawn medics" marching to the dictates of King Reinhardt, let the Medicare Advantage drum beat begin.
- Uwe Reinhardt
- Princeton, NJ
To Van Gross, MD:
I find it ironic that you mention Stan Musial, who played his game subject to many, many rules that constrained his game and whose game was judged by umpires he played it. Musial also undoubtedly got many recommendations over the years on how to improve the outcomes from his the way he played the game. In a sense, he played "managed baseball," although within the constraints of the game he still had enough leeway to play the game as best he knew how -- just as physicians under managed care still have enormous leeway on how to practice medicine. So I thank you for the analogy, Dr. Van Gross.
I recall debating the merits and demerits of alternative health systems with a physician some years ago when I asked him: "To make it short, describe to me your vision of the ideal health system." More physicians should be asked that question.
His response at the time was: "Physician and patient should be free to decide on the therapeutic response to a given medical condition, and the insurer should respect that and pay for it without questioning these therapeutic decisions."
The see the footprints that kind of apporach leaves behind, I encourage you and other readers to click on
http://www.dartmouthatlas.org/
and rummage around that website a bit.
I find it ironic that you mention Stan Musial, who played his game subject to many, many rules that constrained his game and whose game was judged by umpires he played it. Musial also undoubtedly got many recommendations over the years on how to improve the outcomes from his the way he played the game. In a sense, he played "managed baseball," although within the constraints of the game he still had enough leeway to play the game as best he knew how -- just as physicians under managed care still have enormous leeway on how to practice medicine. So I thank you for the analogy, Dr. Van Gross.
I recall debating the merits and demerits of alternative health systems with a physician some years ago when I asked him: "To make it short, describe to me your vision of the ideal health system." More physicians should be asked that question.
His response at the time was: "Physician and patient should be free to decide on the therapeutic response to a given medical condition, and the insurer should respect that and pay for it without questioning these therapeutic decisions."
The see the footprints that kind of apporach leaves behind, I encourage you and other readers to click on
http://www.dartmouthatlas.org/
and rummage around that website a bit.
Don't you love it?? Got to remember to read the commentary sometimes.....
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