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To: Jacob Snyder who wrote (53425)	6/8/2000 4:39:00 PM
From: Les H	Read Replies (2) \| Respond to of 99985

OT Re: incentives They had a nice story on standardized proficiency tests for public schools the other day. Today, there are all kinds of news stories everyday on teachers and administrators helping kids to cheat on the tests so that they can get more government funding. Yet, only twenty years ago, teachers and administrators were feeding kids wrong answers so that the schools would get more government funding. What a world.

To: Jacob Snyder who wrote (53425)	6/8/2000 11:30:00 PM
From: Tunica Albuginea	Respond to of 99985

Jacob Snyder, I agree with everything you said. I will add also that to get out of this hole Americans need to learn that " you get what you pay for, and you must pay for what you get. Message 13827844 TA To: Tunica Albuginea who wrote (53414) From: Jacob Snyder Thursday, Jun 8, 2000 4:32 PM ET Reply # of 53477 Healthcare expenses: 1. The government's (open-ended) obligations to pay healthcare costs, through dozens of different programs, represent a massive lien on present and future taxpayer's income. Politicians buy votes today, and the costs get deferred. 2. I don't know the exact number, but 80% in the last 2 years sounds about right. 3. under the current system, the decision-makers (still mainly doctors, in spite HMO administrators) have zero incentive to control costs. Doctors get paid mainly by piece-work. That is, we get paid more, the more procedures we do, the more pills we hand out, the more patients we see. We don't get paid for results. If we do something, and it doesn't work, then we just do something else (and get paid more). And we don't get paid for being efficient. That means doctors have no incentive to end the heroic end-of-life run-every-test-do-every-procedure routine. As long as those incentives remain in place, patient's (and families') wishes to minimise interventions will often be ignored. 4. in addition to being expensive, those measures are often painful. For instance, CPR (when done correctly) often breaks ribs. The "cost" is not just money. 5. the solution is to give decision-makers incentives to be efficient, and educate everyone about end-of-life choices. If patients knew how painful and invasive (and often useless) these procedures were, many more people would choose minimal supportive-only interventions.