Pushing a string

The latest concept in health care is pay for performance, where a physician is held responsible for measurable outcomes, such as blood sugars, blood pressure, etc. If there ever was an idea that will lead to unintended consequences, this is it! With no power to enforce adherence to therapy, physicians will be further caught between patients who resist lifestyle change and government/big insurance that doesn't want to pay for services. Just as some teachers teach to a standardized test, some physicians will treat to performance. They will find ways to cut loose those who do not adhere to therapy or who have conditions too difficult to control. Others will feel the obligation to treat all patients, only to find their incomes shrinking or even being unable to pay their expenses.

This idea has caught on because there are fewer physcians to monitor than patients, so reward and punishment can be administered to a smaller group.

If we believe that government, big insurance and lawyers are the answers to the problems in health care, why don't we apply these "answers" directly to the general population?

• Taxes on unhealthy foods, used to fund health care
• Taxes on obesity/BMI.
• Taxes on non-adherence to therapy for chronic diseases (pharmacies keep detailed records of med refills)
• Rating of individuals by insurance companies for preventable diseases
• Mandating 1 hour a day of exercise programming on each TV station
• Group exercise in public parks
• Suing patients for doctor-shopping; use of surveilance for those who claim disability.

You get the idea. Bring the chickens home to roost, not for the physicians, but for the individuals who bring up the cost of care by not taking care of preventable and treatable conditions.