A Perverse Incentive is a “driver within a system which works against the overall intention of the system”. (Or as Wikipedia says with an unintended and undesirable result..)
Taking aside the fact that the Wall Street journal is the most right-wing and republican orientated national newspaper, I wonder why Mr Goodman feels the PI are worse with Obamacare than with the alternative that preceded it? He make no analysis of the PIs appertaining to a private and insurance based system where 40% of the population has inadequate or no cover.
The (Regional Health Services) RHSs in the UK have and are developing more and more PIs. Private Finance Initiatives, Private Contractors, Self Employed (GPs) and Trust Executives waiting for Performance related Bonuses are all subject to PIs. The important thing is to make these overt rather than covert, both to the media and to the patient. If patients cannot understand that the PIs to overtreat in private system are mush worse than the PIs to undertreat in a National (basically free) system, then they start at a disadvantage…. It seems Mr Goodman falls into this group.
Dentistry is a good example. Many of the citizens in the UK now have non RHS funded (private) care. Unfortunately this means there is an automatic self-selection where those who cannot afford it get the least care, exactly what the government does not intend… The result, over time, will be an increase in dental related diseases such as Subacute Bacterial Endocarditis. A
Another example could be related to Clostridium Difficile outbreaks in Government Hospitals (virtually unknown in private hospitals) because of the rapid throughput combined with high risk elderly people and the overuse of antibiotics… If managers were rewarded by bonuses for reducing te number of cases then the throughput of the hospital would decline!