Wednesday, January 19, 2005

Health Care Policy

Recently, on a blog devoted to health care issues, the author followed up a number of posts on the evils of medical malpractice litigation with an interesting post on the subject of disciplining physicians. The author suggested at the conclusion of the post that the best means of determining which doctors might be the most appropriate targets for discipline would be to look at those who had been sued a couple of times. I had the temerity to ask the author if he was truly asserting that medical malpractice litigation was the most efficient, cost-effective, and fair means of identifying substandard medical practitioners. He responded by... well, he didn't, and the entire post subsequently disappeared. (The start of this Jan. 5 post can still be found in the rdf feed through bloglines, but unfortunately the substance of the post is no longer available.) Too bad, because I would have been interested in hearing the answer.

Well, perhaps the blog does better when addressing health care policy issues? Or perhaps not. (If any Newt Gingrich fans are reading this, I apologize in advance.) The author of the blog seemingly endorses Newt Gingrich on two points. The first is extremely basic, and is far from being a true Gingrich initiative - improving the technology associated with maintaining and accessing medical records. The second is very much associated with Gingrich, and his particular brand of conservative illogic. That is,
He advocates applying the principles of the “ownership society” to medicine, notably health savings accounts and consumer-directed health care. The idea is to give individuals tax breaks to assume the responsibility for paying more of their own medical costs and to rely less on the government and insurers. Market forces, supporters have said, will bring more options, lower prices and higher quality to health care, as they have done for other categories of goods and services.
One would think that the first logical implication of this proposal would give a health care practitioner pause. Whence the savings, if consumers are deprived of insurance coverage and are looking for health care bargains? Since we've just moved those patients into the category of the underinsured, the savings won't come from improved efficiency from, or reduced profits for, the insurance industry. Hospitals and specialists, offering their higher-priced services, would presumably remain primarily within the scope of health insurance policy coverage, and thus would feel no pain as a result of the anticipated cost-savings. So it would appear that it would be the physicians on the front line - primary health care service providers - who would be asked to reduce their prices, become more efficient, and provide better services as a result of this proposal.

And we are to overlook the fact that general practitioners and internists are already shrinking in number, as doctors turn to higher paid specialties.
According to a recent editorial in American Family Physician, there is still a shortage of primary care physicians and "we [United States] find ourselves behind nearly all of our nation's industrialized peers with regard to health outcomes." For the U.S. health care system to improve, [the American Medical Student Association] believes that 50 percent of the nation's medical school graduates should be choosing primary care careers, including family medicine, general internal medicine and pediatrics.
And we are to ignore the fact that, if this magic market for uninsured and underinsured patients truly exists, private health care providers would already be lining up to serve that market. With close to fifty million uninsured people, and close to one hundred million underinsured people, as ready clients, why don't these magically cheap, high quality clinics already exist? In Texas, where about 25% of the population is without any health insurance whatsoever, why aren't doctors lining up to join this new generation of cheap, high efficiency, high quality practice? Why aren't the major health care corporations building clinics to serve the uninsured and underinsured? Well... because as anybody who actually thinks about the issues, or knows a number of uninsured and underinsured people, is aware, even at a "reduced fee" the cost of primary health care services can exceed the budget of a typical wage earner.

Given how frequently doctors complain on that particular blog that they feel sqeezed by medical malpractice insurance premiums because they are limited in what they can collect by virtue of what insurance companies are willing to pay for their services, it seems peculiar that they are so incurious in response to a proposal that would require them to set their fees in accordance with what the uninsured public would be willing and able to pay.

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