Wednesday, 1 August 2007

U.S. doctor compensation only serves doctors

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The cost of health care is like a kick in the gut. A good friend of mine and her husband pay over $600 a month for their portion of the policy (her small business employer pays the rest), and her family deductible is $2,000. Over $9,000 a year for family health insurance, not including the 20 percent co-pays on each post-deductible bill. If you have a particularly unhealthy year or a chronic disease like diabetes, this can run thousands more until you reach a cap. I thought we had it bad, their costs are double what my family pays. I'm not going to even get into the costs of private health insurance or the plight of the uninsured.

Alex Berenson's July 29 column in The New York Times made me ponder about the rising costs of health care. Berenson points out liberals say our government needs to force cuts in prescription drugs and insurance company profits -- conversatives often claim people need to pony up more of their own medical costs. I nearly coughed up my coffee on that one ... how in the heck can you ask a middle-class family to pay thousands more than they are already paying?

Here is what caught my eye in the column -- Dr. Peter B. Balch, a pulmonary physician and former senior adviser to Medicare/Medicaid stated it is the way doctors are paid that is driving up costs. In the U.S., doctors are compensated for each test or procedure performed, rather than a flat salary. Doctors have financial incentive to drive up health care costs. Primary care physicians and pediatricians make less money ($125,000-$200,000 a year) because they do not order as many complex procedures as specialists raking in $200,000-$300,000 a year or more.

What's even worse is there is hardly a policing system to reign in the stroke of a doctor's pen. H.M.O.s are better at refusing to pay, but Medicare stinks at the job. Dr. Stephen Zuckerman, a health economist at the Urban Institute, explained doctors have steadily increased procedures on Medicare patients, increasing their income from Medicare. Zuckerman further believes these extras have not helped patients much -- there's no strong evidence of improved health status. Medicare and some insurers are timidly moving toward small bonuses for doctor care which meets certain standards, but Dr. Alan Garber, an internist and director of the Center for Health Policy at Stanford University, argues the U.S. needs to pay docs fixed salaries and bonuses based on the health of their patients. Dr. Dana Goldman, director of health economics at the RAND Corporation, stated doctors are misleading themselves if they think the current system serves patients' needs.

You mean a doctor who would spend considerable time with a patient with type 1 or type 2 diabetes to try and influence positive diet and exercise lifestyle changes? Not in this screwed up compensation system, there's no money in it. Don't forget about doctors' ridiculously high malpractice premiums. One big merry-go-round. When will this nation get dizzy enough to stop the ride?

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