Personal Responsibility and Physician Responsibility

NEJM -- Personal Responsibility and Physician Responsibility -- West Virginia's Medicaid Plan: "It is unclear what steps will be taken if physicians do not comply with reporting requirements. The four indicators require data collection from physicians' offices. This requirement for additional documentation is an unfunded administrative mandate that could actually decrease physician participation in the Medicaid program.
In the face of both increasing health care costs and numbers of uninsured persons, states will continue to seek ways to control Medicaid costs. Clinicians often abstain from policy discussions until it is too late for them to have an impact. But who is better able to provide evidence of the misguided nature of such plans? What physician would recommend that a person with diabetes who misses appointments lose the ability to attend diabetes education classes? What physician wants to be faced with a child with asthma whose benefits have been reduced to four prescriptions per month when she gets pneumonia and an antibiotic makes five? In an era of 'personal responsibility,' physicians must assume the responsibility of speaking out about how such policies affect their practices and their patients' health. "