Dumb Payers or Dumber Players

By  |  August 19, 2012 | 

Remember the joke about the man who asks a woman if she would have sex with him for a million dollars?  She reflects for a few moments and then answers that she would. “So,” he says, “would you have sex with me for $50?” Indignantly, she exclaims, “What kind of a woman do you think I am?” He replies: “We’ve already established that. Now we’re just haggling about the price.” The man’s response implies that if a woman will sell herself at any price, she is a prostitute. The way we regard rationing in health care seems to rest on a similar assumption, that it’s immoral to apply monetary considerations to saving lives — but is that stance tenable?

I recently dug this quote up.  The passage is an effective metaphor and describes the U.S. healthcare system perfectly.  Both sides of the ideological divide need to read it, rinse, and repeat.

Congress professing the need to cut the federal budget on Monday to save America’s future, while decrying any attempts to trim health spending on Tuesday is hypocrisy.  Anyone familiar with healthcare knows growth must moderate, and both sides recognize how they want it done.  The right and left, principled in their beliefs and operating philosophies, are certain each will achieve the same result, i.e., more efficiency and less disruption to the healthcare system.  There is no mystery in supply or demand side interventions.  That is the whole enchilada, and you position yourself in one camp or the other.

However, today the news shows left me disgusted.  No political party will accomplish reform on the cheap–or so they will have us believe.  Thus, I will skip the idiotic sloganeering we hear and read daily.  Yet, getting this quote from both sides defies logic:

“In the real world, the result will be fewer providers accepting Medicare patients, and worse care for today’s seniors.”


We cant eliminate providers?  We cant reallocate resources and rebalance our system.  Its positively optional?

Very well then, and in the spirit of bipartisanship, I will take it upon myself to make it simple for Congress.  Pick path A or B:

Now we have established what to call ourselves.  Let us agree on the price.


About the Author:

Brad Flansbaum
Bradley Flansbaum, DO, MPH, MHM works for Geisinger Health System in Danville, PA in both the divisions of hospital medicine and population health. He began working as a hospitalist in 1996, at the inception of the hospital medicine movement. He is a founding member of the Society of Hospital Medicine and served as a board member and officer. He speaks nationally in promoting hospital medicine and has presented at many statewide meetings and conferences. He is also actively involved in house staff education. Currently, he serves on the SHM Public Policy Committee and has an interest in payment policy, healthcare market competition, health disparities, cost-effectiveness analysis, and pain and palliative care. He is SHM’s delegate for the AMA House of Delegates. Dr. Flansbaum received his undergraduate degree from Union College in Schenectady, NY and attended medical school at the New York College of Osteopathic Medicine. He completed his residency and chief residency in Internal Medicine at Long Island Jewish Medical Center in New York. He received his M.P.H. in Health Policy and Management at Columbia University. He is a political junky, and loves to cook, stay fit, read non-fiction, listen to many genres of music, and is a resident of Danville, PA.


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  1. […] 19, 2012 by Brad Flansbaum First posted on The Hospitalist Leader on 8/19/2012 Remember the joke about the man who asks a woman if she would have sex with him for […]

  2. Laurie Bankston August 19, 2012 at 8:29 pm - Reply

    That is terrific! Thanks!

  3. […] a post that is both funny and oh-so-true, Bradley Flansbaum  of the Hospitalist Leader shows us how the right and the left argue their positions on resource allocation so strongly […]

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