It is remarkable that treatises, white papers, editorials, and articles on the cost of health care are consistent with ignoring the essence of care, and they are lacking in physician commentary. Insurance is not health care, and there can be no health care without doctors. Simply stated, in the end after all the intermediaries have claimed their pound of flesh for myriad services that most often provide little to no value, it is one doctor interacting in a mutually-trusting relationship with an individual patient that provides actual health care, not some impersonal consumer in a large industrial corporatist model, and it is certainly not an insurance company or a government program. This will never change, it cannot and it should not.
That physicians need to be the “best and the brightest” is not a cliche. We will all need health care, and it will only be of the highest-quality if the physicians are among the most competent possible. Attracting the best among us to a taxing medical education of 12 to 15 years while consistently reducing compensation, as has been the case for the last two decades, is a formula for mediocrity and an increasing scarcity of medical care.
The cost of doing business as a physician accelerates with each new regulation (the EMR among the very worst), employee salaries, and essentials for care while the reimbursements continue to deteriorate. Early retirement, “burn-out,” decreasing quality of medical students, and the tragic need to escape to hospital employment are the consequences. Physicians were never meant to be employees of megalithic expanding hospital systems. Service to these bureaucratic masters cannot help but negatively influence patient care. These systems are inefficient, bloated with management, and stuck in archaic business models which they defend aggressively. CON laws, Stark laws, non-competes for physicians as hospital employees, myriad regulations, and mandates within a host of payment schemes all prevent physicians from engaging the marketplace with innovation and as competitors. Physicians and hospitals are in different businesses.
It also is denigrating to group physicians as providers. Some physicians are simply better than others. Please realize that urologists, OB/GYNs, orthopedists, neurosurgeons, internists, etc., etc. are absolutely distinguished from one another regarding needs, costs, expertise, and training differences.
Pricing in health care is so far distant from free-market economic principles that calling it a joke is accurate. Medicare and Medicaid set prices arbitrarily, and the private insurance companies are increasingly following their dictates further stressing an already tenuous system for physicians. This cost-price socialism is not sustainable either financially or professionally.
Then there is the other elephant in the room, the direct and indirect costs of so-called “malpractice.” This has broadened into mal-occurrence and has become a growth industry for attorneys. It is costly, destructive, and must be addressed to slow the cost of medical care. Perhaps loser pays with sophisticated juries might be starting points.
Our health care system has evolved into a system in chaos. The chaos only increases with more and more government intervention. Picking at the edges with academics and politicians always without appropriate physician input will continue to yield negative results. For some reason with health care, markets have been ignored.
Tragically, the physicians’ organizations have become political, captured largely by the left. The AMA with its woke policies is a perfect example of O’Sullivan’s Law. Hence, these organizations are no longer the source of majority physician opinion or input and likewise for academics. There do exist physician thought leaders. They must be identified and brought into the discussion for the health care system ever to work and deliver the very best care for all of us who will need it.
Allan Dobzyniak is an internal medicine physician.
