From John Goodman at NCPA:
I first made this proposal to the Bush (43) administration about the time that Geisinger Health System announced that it would not charge payers (including Medicare) for readmissions after heart surgery. Essentially they were saying, โIf we screw up, you donโt have to pay a second time.โ
โIsnโt this an unquestionably good thing?โ I asked a group of folks siting around the table in the Hubert Humphrey Building in Washington, D.C. Everyone agreed that it was.
โSo why donโt you get on the phone and tell Geisinger that a warranty on heart surgery is valuable to Medicare and offer to pay them something for it?โ
โWhy would we want to do that?โ one of the bureaucrats asked me, suspiciously.
โSo then you can tell every other hospital in the country what you have done and invite them to also be paid in different ways if they can save Medicare money the way Geisinger is saving money or in other, better ways,โ I responded, probably showing some irritation in my tone of voice.
โBut Geisinger is already doing what we want them to do,โ another chimed in. โWe could never get away with paying a provider more than we have to pay.โ
โCongress would be all over us,โ a third person declared.
And so nothing happened. The only reason I remember the conversation so well, is that I found it so bizarre.
Anyway, I think there is a huge opportunity here, for any administration โ Democrat or Republican โ to radically change the medical marketplace. In โA Framework for Medicare Reformโ and in a Wall Street Journal article, I listed a few of the hundreds of Geisinger-like providers who are saving Medicare money every year and being financially punished for doing so.
Goodman offers more detail on this approach in his post. One of the most important principles of his proposal is the following: โWe must be willing to tolerate mistakes.โ Thatโs very tough in this domain, but very necessary.






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