Who is the bad guy?

http://news.aol.com/health/story/_a/audits-sting-hospitals-physicians/20080301073809990001

The old days:

• No health insurance. Doctors charged the rich more, the poor less, and gave charity care to the destitute.
• No government intrusion. Medications developed that were not the safest, but at least they worked when nothing else did. Sulfas, penicillin, phenobarbital, morphine and phenytoin come to mind as major contributions to the care of many at the health harm of the few.
• No law suits. Bad things happened, but the presumption of good intent and personal service to those in need led to legal immunity for providers except in the most extreme circumstances.

Now:

• Health insurance pays according to policy and procedure. Charity is replaced by government insurance for the poor, based in part on the proven false belief that the destitute will use health care more appropriately if it is paid for. The need to be in control of costs leads to a concerted effort to portray providers, physicians and hospitals, as trying to defraud the system. To prove fraud, documentation of what was done becomes paramount, as it is the only proof that a service (other than the word of the patient and physician, which cannot be trusted) has been provided. The documentation becomes more and more arcane and complex as the need to increase insurance profits and reduce waste increases. Hired guns are employed to find "fraud and abuse" which includes occasional cases of real fraud and abuse used as a way to justify an all out attack on physicians and hospitals.
• Government controls the insurance industry, directly through the administration of Medicare and Medicaid, and indirectly through insurance commissions. The incestuous relationship eventually brings in large health care providers that develop their own insurance companies. Costs continue to rise in spite of reduced provider reimbursement. Scapegoats are needed and the providers continue to take the heat.
• Malpractice law becomes a thriving specialty as disgruntled patients sue for outlandish sums awarded by juries manned by other disgruntled patients. Communities where disgruntled patients are common become popular sites for change of venue. The field becomes strongly adversarial, and instead of leading to improved care, actually impedes improvement by causing entrenchment.

The future?

• A few bad hospitals and doctors are used to justify a pogrom against all doctors and hospitals.
• Doctors, hospitals and pharma need to stand up to the insurance-government-malpractice lawyer triumvirate, the true axis of evil when it comes to cost, quality, availability and answerability in health care.