I am a scientist and a medical economist. I have been privileged to work beside doctors in both their caregiving role and their research role for 20 years. I have seen their challenges and tried to build products and services to help. I have deep respect for the challenge of medicine and the committed practitioners.
When I left graduate school in 1988, it was the beginning of the movement from fee for service to managed care. I worked in consulting for both a major pharmaceutical company and one of the pre-eminent health care systems in the U.S. At that time, the great push was to gain control of doctors who worked without external discipline and often paid themselves aggressively with reimbursement. The entire focus of medicine was to make things more efficient but also to control the potential for self-payment. This process was mainly aimed at cleaning up the procedure based physicians who were working reimbursement, making exorbitant incomes and buying islands.
Unfortunately, the combination of specialist doctors and litigation attorneys destroyed this healthy movement of doctors managing doctors. In its place insurance and arms-length rationing through absurd pricing and slow service took its place. It started with the heart surgeons and radiologists, but over time, we have applied these control mechanisms down the chain, including the sparsest individual primary care physician. We have made most physicians piecework employees, much like the butchers that separate meat from bone in the meat packing plants around the world.
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