Friday, January 2, 2009

Too Big to Fail?

So I've been pondering the very real prospect of a healthcare bubble bursting, and what form it would take.  I do believe that a lot of our country's leadership will see the solution as being a single-payor Medi-doesn't-care-for-all system.  I must admit, this scares the crap out of me.  Even though the way I, as a hospitalist, am paid assigned disproportionate value to fixing broken people over keeping them well, any meaningful change to our healthcare system could make my contract obselete.  What if RVUs went away?  What if the financial interests of the hospitals were no longer in opposition to that of their employed physicians?  How can I know I'm going to be able to pay my bills?  The thought of being forced into government employment makes me want to wretch.

But something occured to me that gave me solace.  When billions of dollars of banks and financial institutions were ready to crush under the weight of their incompetence and greed, our government deemed them too large to fail.  I have no numbers (but I would love it if someone were able to direct me to them), but I wonder how comparatively "big" all of the country's health insurers are.  What is their annual revenue?  How many people are employed in aggregate by all of these institutions?  It may not eclipse the financial sector... but I imagine it's not insignificant.  If we can't fathom the loss of Ford... what about Blue Cross/Blue Shield?

I have no idea how one could create a single payor system, and yet preserve all of these institutions that have made a career out of keeping money out of the hands of those providing the healthcare, and filling their coffers.  Are they all going to be voluntold into federal/state employment?  With all the resources we had, we couldn't figure out how to get a company that makes shitty cars to make better cars.  How the hell would these same people figure out how to restructure the entire healthcare system?

I think for once, all these companies who have restricted my practice of medicine may protect me from the absolute destruction of physician autonomy.

The enemy of my enemy...

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