August 28, 2012

ObamaCare’s ‘Cheesecake Factory’ solution [Darleen Click]

Certainly, delivering medical care is just like serving up another plate of Crispy Chicken Costoletta.

No one did more to sell the Affordable Care Act than Peter Orszag, the former White House budget director who claimed during 2009-2010 that as much as a third of health spending is “waste” that doesn’t improve outcomes. But now that he’s repaired to Wall Street and writes an online column, he’s deriding the idea that better incentives can reduce costs and sneering at the “health-care competition tooth fairy.”

So get a load of Mr. Orszag’s Tinker Bell alternative, which he called the “most important institutional change” after ObamaCare passed in 2010: the Independent Payment Advisory Board composed of 15 philosopher kings who will rule over U.S. health care.

Who are these Orszag 15? Well, nobody knows. The board was supposed to be up and running by the end of September, but the White House is avoiding naming names for Senate confirmation until after the election. No one knows, either, what this group of geniuses will propose, but that too is part of the grand Orszag plan. […]

Meanwhile, another ObamaCare godfather, the surgeon and influential New Yorker magazine writer Atul Gawande, has further instructions for the medical masses, this time from—believe it or not—the Cheesecake Factory, the chain restaurant.

Dr. Gawande’s point is that medicine would function better if care were delivered by huge health systems that can achieve economies of scale, like commercial kitchens. Care ought to be standardized like preparing a side of beef, with a “single default way” to perform each treatment supposedly based on evidence, with little room for personalization.

No doubt health care could learn a lot about efficiency from a lot of industries, but to understand the core problem with assembly-line medicine, recall that ObamaCare actively promotes medical corporatism. The reason isn’t to encourage business efficiency but for political control. Liberals believe in health-care consolidation because fewer giant corporations are easier for Mr. Orszag’s central committee to control, and more amenable to its orders. […]

The longer-run danger is that Mr. Orszag’s cost board starts to decide what types of care “work” for society at large and thus what individual patients are allowed to receive. One way or another, health costs must come down. And if Mr. Ryan’s market proposal is rejected, then government a la Orszag will do it by brute political force.

The insult to intelligence delivered by Gawande is his glaring omission that the Cheesecake Factory exists and must survive in one of the most competitive (and still relatively free) markets left. Customers have a plethora of choices for their eat-out dollars, restrained only by their personal taste preferences and budget. So Cheesecake Factory must react, innovate and change to keep and expand its base.

But what if The State decided that ‘food is food’ and that people are just too darned irresponsible to be allowed to spend their food dollars on just any old restaurant? What if Government decided Cheesecake Factory was the only model of restaurant allowed, it’s menu to be created somewhere in Washington D.C. by 15 people with little experience in restaurants or cooking (no chefs allowed!) What would happen to all that yummy food, good service and relaxing ambiance if customers no longer paid directly for their meals, but the ostensible “private” chain restaurant was paid a flat fee for everyone that came through the door, regardless of what they ordered. Indeed, the restaurant would be order to offer up “free” with no co-pay for every plate of Tex Mex Eggrolls?

Patients are not the true consumers of medical care – they’ve conceded their own power of purchasing to government controlled “health insurance” and will lose, along with their employers, even more leverage when shuttled into the American NHS with Orszag’s version of the frighteningly-ironically-named NICE.

Paul Ryan is extreme? Well, yeah, Liberty is way overrated. Since “science” is now touting that animals are just like humans, why shouldn’t we just be another herd animal to be managed?

Moo.

Posted by Darleen @ 7:26am
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Comments (10)

  1. The longer-run danger is that Mr. Orszag’s cost board starts to decide what types of care “work” for society at large and thus what individual patients are allowed to receive. One way or another, health costs must come down. And if Mr. Ryan’s market proposal is rejected, then government a la Orszag will do it by brute political force.

    Sounds like a death panel.

  2. I’m thinking doctors aren’t too thrilled about having their years of training and expertise dismissed in being likened to chefs at chain restaurants who are given the corporate menu. And unlike us, they do have a choice – they can leave their profession. Think anyone is factoring this into the equation?

  3. their food is tasty but the desserts are over-rated

  4. Libby, we can bet the doctors are. Attrition at medical schools is starting to rattle the administrators.

  5. IPAB, Death Panel*, tomato, tomahto – that sometimes it’s more humane to starve people to death than waste precious resources keeping them alive (see: Liverpool “Care” Pathway). Oh, and it means we get gramma and granpa’s estate tax sooner, too. Win-win!

  6. OT: PresBO is on teevee yakking about the TS Isaac, and calling it a hurricane. The cocksucker is going to be all over the place today and until the end of the convention.

    He’s like a spoiled four year old at someone else’s birthday party.

  7. My father is a retired doc, and most of his former colleagues and med school classmates are getting out. In addition to this micro-management of what treatments, tests, etc. they can consider, the system is set up so that for small practices, it will cost more in administration (expensive standardized software & paperwork) than they’re allowed to charge for services.
    One other problem with the number of available doctors are women doctors who have decided to work part-time or leave their medical practice to raise their family (I know, not PC to mention this; I have a cousin who did this). There are a limited number of med school students each year, so this has an impact. Which means we’ll become like the UK health system, which is staffed with a lot of doctors trained outside of the U.K.

  8. At least it will be FREE, like it should be, because we have the RIGHT to never be SICK!

    (why do hate the poor and the sick libby?)

  9. Cheesecake Factory? Everybody knows that in the future, all restaurants will be Taco Bell. Also, the bureaucrats will be aghast when you wipe your ass with the citation they give you for not scraping your ass with the three shells.

    As for health care, it will self-correct, since everybody with half a brain will just use their local retired doc to help with routine stuff, and only brave the Department of Motor Vehicles Worker Wellness for really serious stuff. In the end, your State Health Card (don’t call it voter ID!) will function much as catastrophic health insurance did in years past, except with an army of IRS bureaucrats attached.

  10. Dr. Gawande’s point is that medicine would function better if care were delivered by huge health systems that can achieve economies of scale, like commercial kitchens. Care ought to be standardized like preparing a side of beef, with a “single default way” to perform each treatment supposedly based on evidence, with little room for personalization.

    Except the growing trend in evidence-based medicine is that people need personalization because we’re all unique collections of genes.

    Seriously, where’d this guy get his doctorate at? Phoenix University? (No ‘ffense to any Phoenixes out there, but this is the worst understanding of evidence-based medicine of all time.)

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