"Never events." What a great term. In case you haven't heard it, the reference is to complications or outcomes for which, in essence, it's considered (by Medicare) that there's no excuse. Should never happen. No how. And, incidentally, for which we won't pay. The list is expanding.

There's only so much one can say without tearing out one's hair or shooting someone. It seems self-evident: bad stuff happens under the best of circumstances. If you do everything right, manage an incision perfectly with just the right timing and choice of antibiotics, proper preparation, everything done properly, some will still get infected. Given low-dose heparin, intra-operative booties, early ambulation, there will still be the occasional patient with deep vein thrombosis. The best surgeons, doing everything right, will have "never events." Unless they "never" operate.

So where are we headed? To a point, it would seem, where Medicare and -- as is the case as the other insurers inevitably follow suit -- the entire system will expect and pay only for perfect outcomes. And what will be the inevitable result? More and more doctors refusing to accept Medicare patients. And, most assuredly, fewer and fewer people choosing to become doctors (surgeons, anyway!) in the first place. Brilliant.