NYT Opinion: “Doctors’ Pay, a Key to Health Care Reform”

The by-line reads “The Editors” but it’s actually a compilation of Short editorials, two of which are by medical bloggers!  One is the usual suspect, Kevin, MD, and the other is Shadowfax from Movin’ Meat (his real name and a picture with hair is at the NYT).

They’re all good, and all presuppose that the system can be fixed without fundamentally changing the way people (patients) buy their healthcare.

Let patients see the menu, with the prices.  Let hospitals, doctors, and vendors compete, out in the open.  Lift the veil of secrecy about what company x pays vs y, and let’s let the rational consumer decide what they want to spend.  I would trust the wisdom of purchasers over those of government rule-makers every day.


Comments

  1. I agree with you. (But it’s all sooooo confusing—it makes my head spin trying to consider all the different angles……….)

  2. TheNewGuy says:

    And if it makes your head spin… imagine how much less a bunch of beltway lawyers understand healthcare delivery.

  3. “all presuppose that the system can be fixed without fundamentally changing the way people (patients) buy their healthcare.”

    True dat. But bear in mind that I we were given an assigned topic, which was how to change doctor’s incentives. The single payer guys went off on a tangent (who’s surprised?), but I tried to stay on-point.

  4. “imagine how much less a bunch of beltway lawyers understand healthcare delivery.”

    So why do physicians keep leaving it to them to set policy? Although, to your credit, you’re paid better than about anyone else. So you’re doing something right.

  5. “So why do physicians keep leaving it to them to set policy?”

    Is that a serious question?

    We do have a Constitution, you know, under which policy is set by politicians who write progressively more lengthy, expensive, unrealistic, and complicated legislation, that requires a progressively larger army of lawyers and bureaucrats to interpret, apply, and enforce, and which consumes a progressively larger portion of our economy. So you see, it is not really up to physicians to “keep leaving it to them to set policy”, and it never was.

    In order for physicians to set policy, they would have to break into that system which is accurately perceived by most of them to be the problem, rather than the remedy. That system is owned and operated by a different breed of people who are happy with the system and who do not want to relinquish control of it to a bunch of interlopers. The majority of physicians have little patience with such people who seriously believe that man’s laws trump nature’s law. Even if physicians could break into that system and “set policy”, most of them would rather clean out a septic tank using a teaspoon clenched in their teeth.

  6. If you’re not going to get engaged like every other group that has an agenda or a goal then quit crying about the result. Did you think the govt was just going to always give you more and more money? No questions asked?

    It’s you who needs to get serious about lobbying or quit whining and take it.

  7. Matt;

    Q.E.D.

    You make the point quite well, perhaps unintentionally. It is the people who “get serious about lobbying” for “more and more money[.] No questions asked[.]” who are the main cause of the growing problem in our health care system. They include the aforementioned politicians and bureaucrats, the drug companies, the insurance companies, the large hospital companies, and yes, the trial lawyers, all of whom seek to work the system to their advantage through regulation, thereby defeating a sound, rational, and just policy. The people who will suffer from the ensuing mess will not be the physicians, they will be the American people at large. I suppose even a few trial lawyers might be included in that category.

  8. Thales, I feel bad for you. Your predecessors hopped into bed with the government 40 years ago in the Johnson administration. Now the govt. funds over half of all healthcare expenditures, and the insurance industry follows their lead. US physicians benefited quite handsomely, and are the world’s highest paid profession by nearly 50% more than the next. However, you had to know that the costs were unsustainable and it would end.

    Now you want to argue that the government should stay out of your business when you went to their teat willingly time after time. And you’re shocked that their might be politics involved?

    The American people won’t suffer that much because politicians won’t let them and we’re not all sick all the time. Physicians will suffer every day, though, because practicing medicine is all they know how to do generally, and they are in the system every day.

  9. “Thales, I feel bad for you.”

    Please keep your sympathy. It is insincere and you don’t have much to spare. I’ll be just fine, thank you.

    “Your predecessors”….

    You presume erroneously. You really don’t know much about me or my predecessors. Assuming that you mean physicians at large,…

    “…hopped into bed with the government 40 years ago in the Johnson administration.”

    You’re mistaken here. The AMA lobbied vigorously against Medicare and Medicaid because they foresaw what an atrocious boondoggle would result.

    “Now the govt. funds over half of all healthcare expenditures, and the insurance industry follows their lead.”

    “… foresaw what an atrocious boondoggle would result.” We have not seen the worst of it yet, not even close.

    “US physicians benefited quite handsomely, and are the world’s highest paid profession by nearly 50% more than the next. ”

    And your point is? Every single physician I know earns every penny of his income, and then some. If you mean to imply that physicians are overpaid, just wait to see the doctors start disappearing if their pay gets reduced or capped.

    “However, you had to know that the costs were unsustainable and it would end.”

    “… foresaw what an atrocious boondoggle would result.” It will get much worse before it ends.

    “Now you want to argue that the government should stay out of your business…”

    When the government gets into anybody’s business, it usually make a ridiculously inefficient institutionalized hash out of things. There are few areas where this is more obvious than health care, unless you consider things like education, welfare, housing, etc.

    “…when you went to their teat willingly time after time.”

    I did? When was that? And where? Got pictures?

    “And you’re shocked that their [sic] might be politics involved?”

    Politics has a strong tendency to insinuate itself into nearly every human endeavor, including health care. I’m not shocked or surprised at all. Disgusted, perhaps appalled, but not the least bit surprised.

    “The American people won’t suffer that much because politicians won’t let them…”

    You can’t be serious. You think all the people who become ill or injured are going to be relieved by having bundles of statutes and money spewed in their general direction? By having life-saving treatments postponed indefinitely? By waiting in a perpetual queue to obtain a diagnosis as their condition worsens?

    “…and we’re not all sick all the time.”

    Yes, Matt, we all know that we all will live, healthy and happy, completely untouched by illness or injury, until we pass suddenly and peacefully in our sleep at a ripe old age. Matter of fact, it is beginning to look like doctors are completely unnecessary.

    “Physicians will suffer every day, though, because practicing medicine is all they know how to do generally, and they are in the system every day.”

    Yeah; poor, weak, incompetent morons that they are. Good thing that nobody needs them. Thanks for clarifying things, Matt.

  10. Obviously you’ve got it all figured out. Hopefully your arrogance will serve you well as you become a full time employee of the federal government.

  11. Obviously, you haven’t got it all figured out. However, your pious humility will serve you well as you become a full time ambulance chaser.

  12. Kind of like Uriah Heep.

  13. It’s ok. I understand your frustration. I’d be angry too if my industry was barrelling toward wholesale govt takeover and my colleagues and I were mounting anemic defenses to it.

  14. Next time you have a life threatening illness or injury, don’t bother calling a doctor or an ambulance.

    Call a lawyer or a politician.

  15. Single payer is coming our way mainly because of one reason-greed! Greed in the entire system where the patient is the one who gets the short end. Insurance companies-greedy-their bottom line is profit for the share holder, a sick salary for the CEO. Drug companies-greedy-will develop drugs that gets your weiner up because the rich can afford it-ignore what kills millions in the rest of the world, will extract sick amounts of profit from their drugs. Doctors (some not all) greedy-will sell chemo therapy because it prolongs life by two months. Will put pts on the most expensive anti-HTN drug because the drug rep feeds their office and takes them out regularly. Will cath unnecessarily to stick yet another stent in. More procedures-more money-look at McAllen Texas whats going on there? 15K per medicare recipient! Compare that to El Paso Texas-50% of that amt per medicare recipient. Look up Atul Gawande’s article.

    Lawyers-greedy-will try to wring out as much money as possible out of docs and patients-they just want to line their pockets they will shake everyone down for money.
    I am a well paid ER doc and I know that I am a single serious illess away from bankruptcy. I am not living beyond my means. Guys in their late 50s in my group cannot buy insurance-not just expensive-they simply dont qualify because of pre-existing illness-hence have to work until medicare age. Now imagine Joe the plumber making 50K per year or even 100k per year.

    Eventually, the public has had it! Single payer is coming like it or not. This coming from an ER doc. THe doctors have just as much of a role in creating this mess as other players-now enjoy the outcome when the public votes. Everyone has squeezed this system until nothing is left-hence its gonna get shoved down our throat-enjoy.