• Mitch Keamy Photo Mitch Keamy is an anesthesiologist in Las Vegas Nevada Andy Kofke Photo Andy Kofke is a Professor of Neuro-anesthesiology and Critical Care at the University of Pennslvania Mike O'Connor Mike O'Connor is Professor of Anesthesiology and Critical Care at the University of Chicago Rob Dean Photo Rob Dean is a cardiac anesthesiologist in Grand Rapids Michigan, with extensive experience in O.R. administration.

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I have heard discussions amongst primary care physicians on how to "game" the P4P system; people feel justified because they feel victimized by the extraordinarily low reimbursement for Federal programs relative to their practice operating costs; there are no margins, and no prospect of any improvement. I am loath to criticize the system, since I don't really have a good alternative, although I have always liked the German ability to form ad-hoc purchasing coalitions. The reform bill is disappointing to me, since a primary goal was to preserve a for-profit insurance market, in addition to all else. I'm conflicted about that, as well; after all, what's ideologically wrong with a profit based insurance system operating beside a not-for-profit and government? In trying to do too much, it risks not doing anything meaningful, I'm afraid.



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