Here’s a little report on the British end-of-life cost-savings program. It’s called, innocuously enough, the “Liverpool Pathway.” See? Doesn’t that just sound so . . . gentle, so dignified, so . . . DMV-like?
I’m sure we in the U.S. don’t need to worry about any of this happening here, because the Law of Supply and Demand works differently on this side of the water, right? And all our bureaucrats are and will always be (even the ones who haven’t been born yet) moral paragons. So we don’t need to worry about some desk jockey looking over the last three quarters’ numbers and realizing that if he can just get “participation” in this one li’l ol’ program up by, say, 20%, he can free up enough beds &c. &c. &c. Or he can show enough — how was it sold? — “bending of the cost curve” to justify his request for incentive bonuses for the coming budget cycle. And since his program will be operating on an accrual basis, he’ll be able to book the “savings” immediately he “enrolls” the patients in this “pathway” program. Anyone want to bet what’s going to come up at the next management staff meeting?
OK, let’s just assume that our present bureaucrats are moral paragons. Let’s assume that all our present doctors and nurses are likewise so. Let’s assume that they in fact do have the moral fiber to recoil at any or all of the above suggestions. Let’s assume that, over the hundreds of thousands of currently active administrators, doctors, and nurses, the law of supply and demand (the dynamics of which obey the laws of very large numbers, by the way, and operates at the margins of behavior) will be ignored. Our current crop of those folks has been raised in what will become a completely and utterly foreign moral frame of reference from that which will be the only thing the next generations of administrators, doctors, and nurses will know. Their mother’s milk will not be the Hippocratic Oath; they will suckle at the teat of budget justification, of turf wars, of internecine agency power struggles.
I don’t make the above observations as an indictment of government workers. They, like all humans, merely respond to the incentives which are presented to them. Incentives work, even perverse incentives. So when we present the thousands upon thousands of bureaucrats (and let’s be perfectly clear with ourselves and acknowledge that once you socialize medicine, your doctor is no longer the independent practitioner of a noble profession; he’s a government functionary who answers, ultimately, not to you or his conscience but to a chain of command the players in which he probably will never even know) with these incentives, over millions upon millions of distinct healthcare decision points, what is the likelihood that, at the margin, where change occurs, we will get more outcomes like those in Britain described, or fewer?
Once upon a time, I’ll bet, even mooting the suggestion of decision trees like those of the Liverpool Pathway would have been excoriated by every man jack of the British medical professions. It’s taken them roughly 60 years to get from that point to this. Sixty years is not quite two full generations of medical providers (if you figure that, allowing for training and other pipeline activities, you’ll get 30-40 years of practice per generation). Given that morality also seems to follow a path of entropy, what are the chances of the British medical professions finding their way back?
But gee whiz, I’m sure glad that human nature, the law of supply and demand, and everything else works here so radically differently than it does in Britain that we don’t have to worry. I’ll just take my soma and put my nose back to the grindstone.