Article archive / September 1, 2013
Originally published: . Volume 5, No. 1. Source pages: 2.
Jase Robertson, one of the Duckmen from Duck Dynasty, commented on the season premiere that helping his wife decorate the yard for his parents’ renewal wedding ceremony wasn't like work –– “It’s more like torture.” I know exactly what he means. I’m reading the Patient Protection and Affordable Care Act.
We've known for a long time that psychological and behavioral health is a major component of a person’s health, and that 60 percent of medical costs have at least some element of behavior connected. I believe it's a higher percentage even than that, because many of the variables are still unknown. Medicine doesn’t always go looking for them.
So, I'm reading Obama care and besides having to deal with the horrible communication style, I'm thinking every other word something like, “This violates social exchange theory; this assumes the validity of the criterion; this ignores behavior theory; this suggests no intervening variables; this assumes leadership traits that are unlikely…” Torture.
When I drill down trying to understand the federal rules on ACOs, I see that the incentives and bonuses in the shared savings program for Medicare are designated only for physicians, nurses, and physician assistants.
First off, why would anyone hard-wire the incentives and limit who can develop and profit from savings innovations, based on some arbitrary criterion of professional category? We can never really know beforehand where the innovations and excellence are going to pop up. Perhaps the designers were thinking of motivation only (as if that can be predicted). But at least, we should strive to avoid decisions that shout to the rooftops: “What we see is all there is!”
Secondly, someone decided to leave out the professionals who might actually be able to connect the dots and impact health/behavior, truly reducing waste and improving quality. Huh?
The troubling thing for all of us should be that this is evidence of the continuation of the medical model in healthcare, which amounts to a serious dose of groupthink. This suggests to me that political issues are driving the decision-making. I wonder if the public started catching on around 2002, when the increases in medical costs began to decline, and continued to decline, reaching a puzzling, 50-year low.
For now, what's left to those in psychology and behavioral science is to market the evidence-based benefits we offer to the physicians, nurses, and physician assistants, regardless of the errors in Obamacare. It is more uphill than it needed to be, but it is certainly something our community could work on together.
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