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The commonwealth of Massachusetts may soon drastically change the ways doctors and hospitals are paid. Under the current system, health care providers are paid on a negotiated fee for each individual procedure. Massachusetts has created a commission attempting to completely revamp this system; they are proposing a system in which each patient would have a set payment that would cover all their health care costs for an entire year. The “fee-for-service” system “has all the wrong incentives,” said Dolores Mitchell, a member of the Special Commission on the Health Care Payment System and head of the state employees’ insurance program. “It encourages excessive use and does nothing to discourage waste. People know the system has been dysfunctional for years.” While the plan seems to have the good intentions of lowering health care costs in the state, the idea is not practical. First, and most obviously, the idea does not make sense because medical costs are very difficult to structure under one fixed rate. As Dr. James Mongan, president of Partners HealthCare, the state’s largest hospital and physician network stated in early May: “Most of the healthcare system is not structured in a way that could really work out a very rational global payment system.” If doctors and hospitals are supposed to stay under their budget, should physicians refuse to give care to those who have already exceeded their “fixed payment?” Also, what if there is an emergency incident where a patient needs a procedure that would cost much more than their fixed rate? The biggest problem I see, however, is that the government will have much too large of an influence on the health choices of individuals. Who is the government to determine what procedures each person needs? Those choices should still be left up to the patients’ physicians. While the government may view some of the procedures unnecessary, they are not the experts in healthcare. Doctors need to be able to make their informed choices and not operate under fixed payment plans in order to perform the best care for their patients.

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