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Medicare as Auctioneers?

Peter Bach, a pulmonary specialist at Memorial Sloan-Kettering Cancer Center, has an interesting solution for some of Medicare’s problems. In an op-ed column in Wednesday’s New York Times, Bach claims that while medical specialists increase in a given area, medicare costs go up but but patient satisfaction, quality of care and convenience remain the same. In other words, in a place like Manhattan where there are double the amount of specialists as there are in Albany, medicare costs per individual are more than double . However, patient satisfaction and treatment are reported to be the same. The simple solution that Bach poses for this issue is that medicare should use a bidding system in which Medicare should start to offer doctors a reimbursement rate lower than the current rate and see how many doctors sign up. Obviously, if enough doctors do sign up, Medicare would save its users and taxpayers much money. Worst case scenario, Bach argues, is that specialists may leave the system and patients may not be able to get their preferred. However, as Bach notes, the loss of specialists should not result in less quality care.
Bach’s argument makes sense if it is true their is not a difference in quality of care between specialists and general doctors. While many people may not report a difference in the quality of care between specialists and general doctors, I do believe people feel very comfortable with their specialists and would have a difficult time getting a replacement general doctor. While the actual care may be the same, I still feel people many people feel more comfortable with their specialists.

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