“She’s in the pool from 5 to 7 every morning and for another 2 hours after school,” Mom said. “She trains six days a week and has straight A’s. I think she studies too much.” Mom frowns and smiles with concerned pride.
Top athletes structure every detail of their lives around improving performance with physical development and mental toughness.
- An investigation of Elite Sport Performers
- Perceptions of Elite Performers
- Which Character Should Sport Develop?
Medical training shapes physicians’ character as much from ‘The Hidden Curriculum’ as what gets taught formally. The Hidden Curriculum includes all the assumptions and beliefs that define the culture of medical care. Inevitably, the medical profession, including physicians’ attitudes, gets shaped by the medical system.
Medicare changes doctors in ways that may or may not benefit patients. For instance:
- When government pays the medical bills, docs tend to focus on what government wants, not patients’ wants.
- When government controls healthcare, doctors care less about the system, how it runs.
- If medical care is ‘free’, it becomes only correct or negligent. ‘Value added’ holds less meaning.
- Doctors insulated from patients’ ability to pay tend to worry less about costs.
- With increased regulation, doctors avoid regulators’ wrath by ordering more tests. Doctors worry less about costs and more about avoiding trouble.
- Medicare makes doctors appreciate payment from government instead of requests for care from patients. Doctors become thankful to government, less beholden to patients.
- Medical need is what gets reimbursed. Patients’ needs come after need as defined by providers and bureaucrats.
- Third parties define when and where patients should seek care, and from whom. Patients’ opinions are devalued.
- When government pays for all care, reimbursement becomes an expectation from government instead of a payment from grateful patients.
Medicare impacts medicine like spice changes sauce. It tastes different but does not change marinara to alfredo.
Most doctors hate thinking about a patient’s ability to pay during a clinical encounter. Physicians see cost insulation as a major reason to love Medicare. At the same time, Medicare supporters campaign for doctors to take responsibility for spending, to take accountability for healthcare costs. They want doctors to feel the financial pain of their decisions and focus less on churning patients through the clinic.
Built on the Past
Athletes can cheat for a few days and still perform better than the rest of us. But eventually lifestyle influences performance.
The first 10 years of Medicare made Canadians proud. Politicians claimed success for great legislation. Socialists claimed a win for collectivism. But as Medicare crumbles, politicians blame everything other than legislation and political outlook.
The golden years of Medicare brought outstanding results because of the character and culture into which it was placed. Like giving an athlete a new training program, Medicare introduced a whole new set of assumptions about need, value and who is the real customer.
To use another analogy, introducing Medicare in the 1960s is like a toddler placing her teddy bear on top of a stack of blocks. Her tower looks amazing for a second. However, her destabilized creation inevitably crushes all her work.
Looking around for reasons why Medicare under performs is like asking why the teddy bear fell or why an athlete fails after years of not training. Medicare stood on the success of character built over years before. Medicare introduced a new element into a complex system that modified the fundamental character of the whole.
Medicare changes doctors and patients. It altered the medical profession. Does it still bring the change that patients need?
photo credit: telegraph.co.uk