25 January 2013
Inconsequential New Senate Filibuster Rules
Those of us who, like me, just don't take action on an unpleasant task until we're forced to by the passage of time, should sympathize with Harry Reid's dilemma. He and most of his colleagues in the Senate, both Democratic and Republican, were not elected to get anything done; their elections were paid for by special interests that would rather see the Presidential administration paralyzed by a recalcitrant legislature.
This may be a reflection of the deep suspicion of our republic's founders and of our vociferous mugwumps towards monarchs and other ruling elites. "What right do they have to impose regulations on the rest of us?" There is a constant rivalry in our system of government between the ideals of a democratic electorate and those of private enterprise.
The powers that be in our economy are content to see Washington flounder because of its silly filibuster rules and to take advantage of government spending programs when they can pay for projects, goods and services that no one else has the money to buy.
Those of us who, like me, just don't take action on an unpleasant task until we're forced to by the passage of time, should sympathize with Harry Reid's dilemma. He and most of his colleagues in the Senate, both Democratic and Republican, were not elected to get anything done; their elections were paid for by special interests that would rather see the Presidential administration paralyzed by a recalcitrant legislature.
This may be a reflection of the deep suspicion of our republic's founders and of our vociferous mugwumps towards monarchs and other ruling elites. "What right do they have to impose regulations on the rest of us?" There is a constant rivalry in our system of government between the ideals of a democratic electorate and those of private enterprise.
The powers that be in our economy are content to see Washington flounder because of its silly filibuster rules and to take advantage of government spending programs when they can pay for projects, goods and services that no one else has the money to buy.
24 January 2013
Doctors’ Performance-Based Compensation
On January 11, 2013, the New York Times published a report that New York City Hospitals would tie their doctors’ performance pay to “Quality Measures.” Those measures included several criteria over which doctors complain they have no control. Even a shoe salesman depends on the luck of the draw for the amount of his compensation. It is a complicated topic that a newspaper article certainly can’t do justice to.
Here’s the thing--How did we ever get into the situation where doctors earn more when they sell more—procedures, hospitalizations, medications, equipment, referrals, etc.? It’s easier to measure, sure. But it ignores the fact that health is a community responsibility—any individual will have trouble maintaining his health in Beijing today, what with its record degree of air pollution. Flu vaccinations, second-hand smoke, water and air pollution—the cases are endless where the well-being of each of us depends on how healthy we all insist on keeping ourselves.
Doctors practicing today are increasingly unhappy with their loss of professional discretion to the rule of health maintenance organizations. If I were a doctor, my morale would be poor not so much because of compensation as because the earth is such a hazardous environment for human health and we can’t seem to improve it fast enough, even though we know what needs to be done. (Pogo was depressed, too, when he said “We have met the enemy and he is us.”) It’s unfair to doctors to tie their compensation to things over which they have no control. It is also unfair, however, that the health of each of us is affected by conditions that none of us can change on our own. So another parameter of a good doctor’s performance should be their political activism to foster the community’s assumption of responsibility for creating a healthy society.
On January 11, 2013, the New York Times published a report that New York City Hospitals would tie their doctors’ performance pay to “Quality Measures.” Those measures included several criteria over which doctors complain they have no control. Even a shoe salesman depends on the luck of the draw for the amount of his compensation. It is a complicated topic that a newspaper article certainly can’t do justice to.
Here’s the thing--How did we ever get into the situation where doctors earn more when they sell more—procedures, hospitalizations, medications, equipment, referrals, etc.? It’s easier to measure, sure. But it ignores the fact that health is a community responsibility—any individual will have trouble maintaining his health in Beijing today, what with its record degree of air pollution. Flu vaccinations, second-hand smoke, water and air pollution—the cases are endless where the well-being of each of us depends on how healthy we all insist on keeping ourselves.
Doctors practicing today are increasingly unhappy with their loss of professional discretion to the rule of health maintenance organizations. If I were a doctor, my morale would be poor not so much because of compensation as because the earth is such a hazardous environment for human health and we can’t seem to improve it fast enough, even though we know what needs to be done. (Pogo was depressed, too, when he said “We have met the enemy and he is us.”) It’s unfair to doctors to tie their compensation to things over which they have no control. It is also unfair, however, that the health of each of us is affected by conditions that none of us can change on our own. So another parameter of a good doctor’s performance should be their political activism to foster the community’s assumption of responsibility for creating a healthy society.
