There is a cadre of reformers that believe if only doctors where on salary then all would be well with health care economics. Heath costs would be curtailed and our economy would be robust and without the drag of excessive health care costs. Yet, what they all seem to miss is that many of the doctors who work in these systems (Mayo, Cleveland, etc.) earn good salaries, but are the beneficiaries of tax payer largess. How? By the extensive federal funding of medical eduction which allows these staff members to have fellows and residents take call, stay in the hospital, be the first responders for most medical and surgical emergencies. These medical education based ‘indentured servants’ provide innumerable benefits for the doctors in these systems. These perks allow these physicians to have a much more lavish and comfortable lifestyle than most physician in private practice. Still, if the benefits are so great, then why are not the vast majority of physicians clamoring to work for or to create systems of the type hyped in this article. Why? Because most physicians are ardently devoted to personal freedom and the ability to interact with patients in a way that is personal and unique to them. They do not wish to be part of a cookie cutter, clinic system that treats all patients the same, usually as clinic numbers, and treats doctors as technologic commodities. It is also true that many of these clinics are referral clinics, treating unique and complex cases and not doing much of the day to day health care that so many in both primary and speciality care do. Forcing doctors on to salary would be among the most counter productive measures we could ever take in attempting to achieve real health reform. Allowing doctors freedom to choose their style of practice has long been the key to the overall high quality of medicine practiced in the United States and can be an asset as we work toward Real Health Reform . . . obi jo and jomaxx
Changing those policies is crucial to the success of health care reform, economists say — something Mr. Obama said that he would do. “Our proposals would change incentives so that doctors and nurses finally are free to give patients the best care, not just the most expensive care,” the president said Thursday in Ohio.
Doctors in the United States are usually paid fees for each service they provide. The more procedures and tests they order, the more money they pocket. There is widespread agreement among health policy analysts that many of these procedures are unnecessary, raising costs in ways that often do nothing to improve patient health.
By contrast, Bassett — like the Cleveland Clinic and a small number of other health systems in this country — pays salaries to all of its doctors. No matter how many tests or procedures are performed, they take home the same amount of money. Medical costs at Bassett are lower than those at 90 percent of the hospitals in New York, while the quality of care ranks among the top 10 percent in the nation, surveys show.
Hospital Savings: Salaries for Doctors, Not Fees – http://www.nytimes.com/2009/07/25/health/policy/25doctors.html?ref=health
www.condron.us
…cookie cutter, clinic system that treats all patients the same, usually as clinic numbers, and treats doctors as technologic commodities.
Is that how Mayo operates? Or the VA? Or the Armed forces professionals?
Who knew?
btw, it’s still a free country. No one is forced to work anywhere. And a few more cookie cutter clinics with salaried licensed professionals would be welcomed by a lot of people now in need of care. (Why else would mini-clinics be cropping up in retail environments?)
I worked with the working poor my whole career and I can assure you that any one of them would have gladly gone for cookie-cutter medicine rather than none at all.
But all this talk about health care is a distraction. This discussion is about insurance.
John, you are correct it is about insurance. But there are many other issues that are being clumped together by the House and Senate which do not need to be here. They are clouding out chances of real health insurance reform.
As for the store front clinics, many young doctors did these for years, for free. They did not catch on. Surprise. WalMart and Walgreens were not too interested then. Now that the feds are going to pour money into them, WalMart and Walgreens are gung ho. One of the main reasons for this is that reimbursement for basic primary care services is so low that many primary care physicians do not even offer some of these services (flu vaccines and basic childhood immunizations). Why? Because they almost always LOOSE REAL MONEY in providing the service as the are paid generally less than the vaccines cost them and the professional component of providing these services is miniscule. By perspective, there overhead is enormous, Walgreens and WalMart do not have that same issue. This is a cottage sideline for them to get customers into their pharmacies/drug stores/general merchandise stores -they are hardly clinics in the true sense of the word . . . obi jo
Makes sense to me.
So what are those “other issues” that don’t need to be there?
I know that Medicare rates are in the pork column and giving more authority to MedPac or some similar independent advisory group is a sticking point. That’s not about insurance (except that the industry shares the pork).
What else?
And if limiting reform to insurance “exchanges” alone strikes me as a political grenade that would galvanize the industry as nothing else could do. As it is, the industry can’t complain as much without appearing to be self-serving. I haven’t read any public discussion of the exchanges, but my impression is that they are a mechanism aimed at curbing insurance exploitation of the status quo.
Meaningful health insurance reform and regulation are the heart and soul of any Real Health Reform. I think that insurance ‘exchanges’ are just another layer of red tape. Individuals need to be able to access policies from any source offered. The problem with the public option remains that once in place, it will eliminate all private coverage alternatives. Don’t believe me? We have asked repeatedly what is the primary health coverage alternative to Medicare. There is none. It does not exist. Only private supplements are available, and they for the most part cover only what Medicare will cover.
MedPac already has great influence on payments and coverage determinations. Not sure how Medicare rates are in your ‘pork column’, unless you think paying doctors and hospitals is an unnecessary expense and those folks and institutions should receive no compensation for their efforts. But, as you say, the issue is health insurance first and foremost.
“Not sure how Medicare rates are in your ‘pork column’, unless you think paying doctors and hospitals is an unnecessary expense and those folks and institutions should receive no compensation for their efforts.”
Easy. NPR reported the same last week.
http://www.npr.org/templates/story/story.php?storyId=106770518
The administration also sent to Congress its own legislative proposal to aid in the cost-cutting goal — its first formal contribution to the health care effort.
The idea is based on one that has already been floating around on Capitol Hill for the past several weeks. It would significantly beef up the power of an existing agency known as the Medicare Payment Advisory Commission, or MedPAC.
“Every year there’s a new report that details how much waste and inefficiency there is in Medicare, how best practices are not always used, and how many billions of dollars could be saved. Unfortunately, this report ends up sitting on a shelf,” Obama said.
Under the president’s plan, MedPAC, or a new independent board just like it, would come up with a set of payment recommendations for health care providers, which the president and Congress could approve or reject, but not amend.
I have also heard reference to the same sticking point in a couple of C-SPAN snips.
I don’t think anyone thinks that “paying doctors and hospitals is an unnecessary expense and those folks and institutions should receive no compensation for their efforts.”
I do think, however, that Congressional thumbs get on the scale for reasons of pork more than medicine.
The references I have heard (sorry, no links here) include oxygen, medical devices and some high-end expensive treatment options. The implication is that some districts are more equal than others. I also heard objections to med-pac having more control, or (horrors!) some similar independent commission with teeth deriving their decisions from data not driven by politics.
MedPac does make recommendations and yes, many of those are not followed by Congress. However, to have a truly independent board, making decisions of this type, without the ability of citizens to petition their representatives in Congress is a fundamental distortion of American principles. Any petitioning of Congress, whether done by individuals, groups, unions, businesses, corporations or interest groups amounts to a form of lobbying, but is essentially an expression of 1st Amendment rights of free speech. To remove from doctors, hospitals, pharmaceutical companies, device manufacturers, other medical providers and service companies the ability to influence or comment on payment schedules would be fundamentally unfair, in our opinion. However, that does not mean that we do not favor an expansion of MedPac influence which should include input from those affected prior to an congressional up or down votes.
The description I have heard of the proposed authority would have those “recommendations” submitted to Congress as packaged deals for an up or down vote, but without micromanaging.
From the shape of the public discussion, however, our conversation won’t matter much anyway. Looks to me like despite official optimistic spin, the plan will either die the death of a thousand cuts or pass castrated, a steer instead of a bull. I know I’m getting tired of keeping a stiff upper lip.
The majority of Americans are insured and satisfied with what they currently have. To me we are like the proverbial frogs being cooked alive little by little, blissfully adjusting to the heat until it reaches the point past which we can jump to safety. At sixty-five my wife and I will be okay, but I feel bad for our grandchildren.
Empty chatter about the free market is a shower of platitudes ringing in my head. What that market has generated during my adult life is the most spectacularly expensive medical care on the planet protected by unmeasurable amounts of money shaping public opinion in the guise of free speech.
John, thanks for the comments. The recommendations as you point out would have to be voted up or down. However, we remain concerned that those affected, all of those on all sides, must have their democratic freedom to petition their representatives for redress of grievances which would mean allowing them to make statements regarding their concerns or positions on reimbursement for services. It is certainly possible for this process to be worked out and still improve the input of MedPac into the equation.
On the whole, there is no need to despair, there remains hope that common sense Real Health Reform can emerge from amidst the chaos of the democratic process of our Republic. Make laws it is said is a lot like making sausage, not very pretty to see up close. So it is with a “animal” as big as health care. One that is important, large both economically and structurally as well as one that touches each and every citizen (at least sooner or later).
The