Jeb Bush released his health care plan (short, long) today (though not a Medicare plan, which will come later). Also today, the New York Times ran this article by a doctor at New York's Bellevue Hospital, suggesting that ObamaCare hasn't yet succeeded in fixing the incentives of physicians:
our reimbursement system favors procedures over discussing and thinking about a case. That is, more money would be paid out if I ordered a magnetic resonance imaging exam for my patient with abdominal pain than if I spent extra time talking with her and sorting out the details.
If I called a colleague to get extra input on the case, or spent time with the nurse who knows the patient, or called a radiologist to discuss whether I actually needed that M.R.I. or could get by with a less expensive ultrasound — none of that would be reimbursed in our current system. Nor would additional phone calls or emails with patients and families, who are arguably the true experts on the case.
Talking about reimbursement may reinforce the stereotype that doctors only care about money. But in reality, if something is not reimbursed, it is hard to get done because there are only so many hours in the day. As a time-pressed clinician, it would be faster, easier and more lucrative for me to simply order the M.R.I. than to actually think about my patient's case.