Monday, December 16th, 2013
Can doctors rein in health care cost? No
Pioneer Press TwinCities.com-Pioneer Press
The title of the excellent article by reporter Chris Snowbeck on a survey of doctor opinions says it well;
“Can docs help rein in health care costs? Not our job, they say” (July 24, 2013).
The survey reported the usual litany of alleged cost culprits: trial lawyers, HMO corporations, hospitals, and so forth, which points out the fallacy of finding the cause of medical cost inflation using opinion surveys. Over the last two decades the HMO industry, and, as mentioned in the article, ObamaCare acolyte Ezekiel Emanuel, have successfully convinced politicians and pundits that doctors are the cost culprits.
The reality is that the tipping point for medical cost-price inflation began after 1965 when 85 percent of the population (employed workers and the official old, poor and disabled) suddenly acquired tax-subsidized health insurance. The appearance of near-free care (the boss or government pays for it) and subsequent unrelenting demand has not been stopped in over four decades by gatekeeper schemes. These include government price fixing of services and legalization of profit-driven rationing of care by HMO corporations.
These are the mega “payer” schemes over which doctors have no control and which have broken the financial back of too many medical practices.
How then did we get to the Patient Protection Affordable Care Act (ObamaCare) methods to police the “culprit” doctors?
The payers and acolytes make three specious, evidence-free claims: First, that medical inflation is due to “poor quality” and profligate care by culprit clinicians driven to ignoble avarice by the evil fee-for-service system. Second, that costs would be contained by transfer of mega-payer rationing to the doctor culprits through annual capitation payments to Accountable Care Organizations (ACOs) for servicing payer populations. Third, that ACO physician gatekeepers could gain redemption when their profiteering is
enlisted at the bedside in the more noble cause of conserving society’s scarce resources — code for protecting corporate and government agency treasuries.
What’s wrong with this authoritarian attempt to ration care by paying doctors for rationing care at the bedside?
It didn’t work in the 1990s for three reasons: Doctors proved loyal to the interests of their patients and not to corporate bottom lines; doctors have no control from the bedside over the political tax subsidies driving the apparent price of a dollar’s worth of care down to about 13 cents; and doctors have no control over government agency price-fixing of services or blunt corporate barriers to care.
To paraphrase the economist John Cassidy: no central authority can accomplish the functions of freely determined prices for the allocation of labor, capital, and human ingenuity, however brilliant (or good-willed) the managers. Until this economic reality sinks into the public and political mind-set, we’ll see more surveys of uninformed opinions and more specious accusations of culprit doctors that originate from those authorities anxious to hide managed-care cost-control failure and profitable rationing schemes.
The job of doctors is to take care of patients. Doctors cannot solve the political problems of tax-subsidized medical inflation and its rationing of care schemes gone awry.
Robert W. Geist, North Oaks
The writer is a retired medical doctor