Summary
Contrary to popular belief, the palliative effects of buzz words like integrated care, managed care , performance based compensations etc may sound utopian in non-clinical settings like Wall Street, the Congress and even Main Street, but as a physician in private practice, I can assure you that any healthcare system, bereft of physician independence at it's core, is necessarily fatally flawed - the Mayo Clinics and Geisingers of the world not withstanding. As someone who fled such an "integrated, socialist, and corrupt" healthcare system in the India of the late 1980s, the U.S. health system, flawed as it was in many ways, provided the liberating gasp of fresh air in the independence that all scientists and doctors yearn for, after dedicating the prime of their youth training for such an opportunity. Healthcare reform should look to big ticket items like liability reform, administrative reform, fraud and abuse etc before they pick on doctors.
Analysis
The prospect of practicing in the much touted " integrated, affordable, guidelines based, bundled fees and bureaucratic " health care system is revolting to most self respecting physicians, and if passed, we would be happy to drop out of the whole thing and charge our own fees. In fact, that is already happening in affluent neighborhoods where high quality physicians have dropped most insurances and Medicare and set their own fees that the patients are happy to pay.
Like most other countries of the world, we are destined to have this two tier system of healthcare - one affordable, dubious quality, integrated system mostly manned by paramedicals and lazy physicians for the vast majority and one for the elites who can afford the quality physicians and hospitals for Cadillac care. It would be a shame, but that is where we are headed - a definite step back from the acme of American medicine in the 80s and 90s, when the US health system was the Mecca for medicine.
