There is a huge push for payment for quality, payment for outcomes. Neither of these are defined in any sort of consistent, concise fashion. Not for one single diagnosis across the board in medicine.
It fails to take into account that the patient is the one and only arbiter of what goes into the mouth, what smokes go into the lungs, etc. Physicians are no more responsible for the behavior of patients than the plumber is responsible for the behavior of your toilet or the auto mechanic for your car. Nobody is addressing the fact that we don't have cures or favorable outcomes for everything. People all will eventually die. Mortality is a metric that dares not be breathed into any discussion.
Health care in this country isn't really about prevention, we can try to prevent every bad thing but people will, and can get, randomly--or genetically determined--illnesses such as lupus or leukemia. We need to differentiate between sick care and health care. Doctors promote health by treating and sometimes even conquering illnesses. But we generally don't go out there and lay waste to every cigarette counter at a local supermarket or set fires to Dunkin Donuts. Do these items promote health? No. But it's a free country and I will not agree with your cigarette and donut, but I will defend your right to get it. I will not participate in any insurance plan that requires my clicking of a box on smoking cessation counseling or trans fat free dietary management.
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