When salaries get so enticing, who can resist?
Are doctors what ails U.S. healthcare?
| What’s behind the doctor clusters? If medical practitioners did not enjoy so many privileges -- medical licenses, drug patents, bureaucratic regulations -- could they charge nearly so much? For these government granted privileges, should we the public charge the market rate? Should we allow more competition? Should we pay ourselves medical vouchers, a quasi-Citizens Dividend? We trim and blend two 2009 articles from (1) Reuters, Nov 5, and (2) Joel S. Hirschhorn, Nov 1. |
by Chris Baltimore and by Joel S. Hirschhorn
In the United States, for every doctor who lives and practices in an underserved area, four others settle in an overserved area. What's more, clusters of doctors tend to result in higher health care costs. And outcomes aren't any better in cities with the largest physician populations.In wealthy US cities, more doctors are associated with higher costs of care and more procedures that have dubious benefits for patients.
According to a report from Robert Kelley, vice president of healthcare analytics at Thomson Reuters, the US healthcare system wastes between $505 billion and $850 billion every year.
One reason is the "fee-for-service" structure of the US healthcare system, which rewards specialists for performing complex procedures but offers less to primary care physicians who practice preventive medicine.
Primary care doctors must see about 35 patients a day -- which works out to less than 15 minutes per visit -- to make $150,000 a year, if they rely on the government's Medicare system fees.
Meanwhile, a brain or heart specialist can easily make four times that by performing complex procedures.
At Westchester Medical Center near wealthy White Plains, Medicare spending was about $87,000 in the last two years of life, and during the last six months of life patients spent an average 24 days in the hospital and were seen by 53 physicians.
Meanwhile, at Mercy Hospital in low-income Bakersfield, Medicare spending was $57,000 in the last two years, and patients spent an average 14 days in the hospital in the last six months and were seen by 40 physicians.
In rebuttal, some doctors argue that wealthy areas are not overserved but poor ones are underserved.
Yet the United States spends more of its gross domestic product on health care than any other developed nation at 15 percent -- versus 11.3 percent in Switzerland, 10 percent in Canada and 8.1 percent in Japan.
President Barack Obama has made reform of the $2.5 trillion US healthcare industry, which constitutes one-sixth of the economy, his top domestic priority.
Yet, even if Obama gets everything he wants, thereby widening the $1.4 trillion US budget deficit, the bill being pushed in Washington is likely to have little impact on soaring costs and uneven quality of care in the United States.
For anyone looking to pay the bill for health care reform, consider the map. States like Wisconsin, Minnesota, and North Dakota have maintained low costs by relying on primary care doctors to keep patients healthy and out of hospitals. Meanwhile in high-cost states like New York, patients are more likely to get admitted to hospitals and receive a battery of tests and treatment.
Billions of dollars in costs can be eliminated through improved efficiency, rather than through more government spending that would not address uneven distribution of doctors.
Joel S. Hirschhorn: My doctor told me about dealing with private health insurance companies. They take up huge amounts of time of him and his staff, trying in every possible way to deny services to their customers (his patients) and also to pay as little as possible to him. His endless struggles with the insurance companies make his life miserable.
He is incredulous at how executives of private insurers make vast amounts of money while making physicians and their patients suffer endless annoyances and negative impacts on health care. And they get away with making people pay more and more money for worse and worse insurance.
He also has many stories about patients that do not take medications for long term chronic conditions because they cannot afford prescriptions. He gives out as many samples that he can get and is angry that people in other nations pay much less for brand name drugs.
My doctor believes in opening up Medicare to everyone. While no one should be forced into Medicare, just making it available to all who want it would be fair. If private colleges compete with public ones, and private for profit hospitals compete with nonprofit ones, why shouldn’t health insurance companies be put in a similar position?
Why? Because Congress receives huge amounts of money from medical insurers. Remember that the next time you vote.
[Contact Joel S. Hirschhorn through delusionaldemocracy.com]
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Also see: There A Mean Streak in the US Mainstream?
Childbirth -- Can the US improve?
It’s the little things that add up. |
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