Today's Debate: Doctors vs. Insurers

Physician and blogger Stanley Feld has launched a crusade against the insurer-led health management system known as pay for performance, or P4P.

In a series of posts to his blog (1,2,3) Dr. Feld describes the "quality" measures used by many insurers, their disconnect with patient outcomes and real costs, along with the real world damage they do to doctors.

He concludes:

It is time for employers and consumer alike to say we are not going to take this any more. It is time to demand that the government set up rules that treat everyone fairly. If the consumer drives the healthcare system the consumer can make this happen. It is time for the insurance industry to realize it is killing the goose that laid their golden egg.

But there is a big problem with his call for physicians to attack the insurance industry.

They're outgunned.

Insurers have the automation advantage over physicians, and they are pressing that advantage.

Insurers have enormous databases, computer networks and payment processing systems, which give them the whip hand in any confrontation with the medical profession.

Dr. Feld's solution is to unite with patients and government. So the question becomes, which do doctors fear more, the government or the insurance industry?

On that question hangs the fate of health care reform.