If you have been reading and observing healthcare debates the perspectives keep piling up. Even with the best of intentions it isn't possible to fix the US healthcare system and retain the status quo market driven cost and profit foundation.
Somewhat naively I envisioned the value paradigm as one way out--until I listened to debates in Washington of how Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) would incentivize high-value care allowing ridiculously generous payouts to hospitals and physicians alike. It seems like "first do nothing" never made the cut.
The Lown Institute, Choosing Wisely, National Physician Alliance (The Unbranded Doctor), and Preventing Overdiagnosis are all organizations acknowledging the risks of too much medicine/intervention. Unfortunately many of the value algorithms and frameworks for high-value care are intervention heavy. I don't see a big difference between fee for service and fee for this service instead of this one (value).
Thoughtful discussions about content development and outcomes analytics that apply the principles and frameworks of health policy and economics to persistent and perplexing health and health care problems...
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In a world of "evidence-based" medicine I am a bigger fan of practice-based evidence.
Remember the quote by Upton Sinclair...
“It is difficult to get a man to understand something, when his salary depends upon his not understanding it!”
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