Maggie's Farm

It's really simple and doctors aren't (all) stupid.

Very few doctors are still paid by their patients. Instead, they are paid by government programs (such as Medicare) or by an insurance companies selected by an employer.

There's a big difference from just 25 years ago. Back then, most doctors who took Medicare or insurance didn't "take assignment". They billed the patient and then sent a copy of the charges to Medicare or the PATIENT'S insurance company which then reimbursed the patient using its own fee schedule. There were two contracts - one between the doctor and the patient and another between the patent and the insurance company (or Medicare).

Today, the contract is between the doctor and Medicare or the EMPLOYER'S insurance company. Note the difference that occurs when the patient selects his own insurance company and when one is mandated for him by his employer - who do you think the insurance company listens to?

Today's doctors understand who is paying the bills and who is just a passive player with little choice. Patients over 65 are captives of Medicare. Patients under 65 are captives of their employer's insurance company. Doctors respond to those who are paying them rater than those who are simply along for the ride.

Contrary to what seems to be a common misunderstanding, the government's reason for forcing doctors to use EMRs has nothing to do with better or more efficient medical care - at least as the patient and doctor interpret "better". Rather, it's so that the government can monitor, and hence control, what doctors are doing (and what patients are receiving).

The government knew that they couldn't sell this system of "oversight" - which is evolving into a system where federal officials tell doctors what they can and cannot do and patients what they can and cannot have - for what it really is. So, they did what they usually do - they created the perception in voters that they were crafting these rules to lower costs and improve quality.

Now, to be fair, this didn't start with Obama. The purpose of HIPAA, signed into law by Bill Clinton, wasn't really to ensure patient's privacy. It was meant to create the illusion of privacy while granting the government greater access to your medical records and making it easier for the government to collect information about which doctors were "outliers", i.e. those doctors who provided - in the government's opinion - "too much" care.

Electronic medical records may have a place in helping doctors provide better care, but not when they are forced on doctors and certainly not when the data that MUST be entered is determined by the wants of the government so that it can monitor and control rather than the wants and needs of the doctor so that he can provide better care. If EMRs truly improved outcomes and lowered costs in a trade-off that was desired by consumers (doctors and patients), there would be no need for government to enforce their use.