Skip to comments.Why Pay Physicians Anything At All For Providing Healthcare?
Posted on 03/18/2013 8:35:03 AM PDT by Kaslin
Last week, the National Commission on Physician Payment Reform released its recommendations, calling for the elimination of fee-for-service healthcare within the next 5 years. This organization, funded by the Robert Wood Johnson Foundation, is populated by physicians from academia, the insurance industry and from the public policy world. Having former GOP Senate Majority leader and cardiac surgeon Bill Frist serving as honorary chairman gives the imprimatur of bipartisanship and legitimacy. However, Dr. Frist, a former academic himself, has long favored a government supervised healthcare system, and is therefore less than objective in this regard.
The Commission was formed to assess by what means and how much doctors should be paid. Their position is that payments to physicians are one of the key drivers of escalating healthcare expenditures. They want to pay for the sustainable growth rate (SGR or "doc fix") by cutting physician payments for services, just as they aspire to hasten the implementation of the Affordable Care Act by fast tracking new and unproven concepts such as accountable care organizations (ACOs), patient-centered medical homes and value-based purchasing.
Sadly, the objectivity of this group has been clouded by its ideology and perhaps itsself-interests. Although physician payment is one of the components of healthcare costs, it is hardly the major driver. According to a 2012 study from Jackson Healthcare, compensation to physicians was 8.6% of healthcare costs, or $216 Billion annually- amongst the lowest of the major Western nations. Germany spends 15% of their healthcare costs on physician compensation, Australia 11.6% and France spends 11%.
Placing blame for runaway healthcare costs solely on physicians is simply an attempt to divert attention from the real perpetrators. In his recent Time magazine feature story, Steven Brill painstakingly outlined how hospitals throughout the country are generating obscene charges and profits. Over 30% of healthcare spending is generated by hospitals, a large share of which goes to managers and executives; many taking home seven figure salaries. Ignoring this, the Patient Payment Reform Commission wants to give the hospital administrators, through the new ACO model, even more control by directing payments to them, effectively making them the gatekeepers of reimbursements. The false narrative that has been created for public consumption is that in doing so, savings are created by consolidating and delivering care more efficiently and effectively. So far this is simply false.
Two of the major drivers of out of control healthcare spending are medical liability and the 3rd party payment system.
Medical liability costs, both the money spent to defend claims and the awards, is greater in the United States than in all of the Western democracies combined. The largest contributor to these costs comes from extra tests ordered by physicians, to protect themselves from frivolous lawsuits-defensive medicine. A Harvard study in 2008 calculated these costs to be about 2.4% of healthcare spending or $65 billion annually. The 2011 newsletter of the American Health Insurance Plans (AHIP) reported that these costs were actually somewhere between $650-850B annually.
The 3rd party payment system is perhaps the most potent driver of runaway healthcare spending. Without any restraint on spending, largely because individuals are disconnected from the costs of their healthcare, patients routinely expect tests and procedures that may be unnecessary simply because someone else is paying the bill. Doctors have little incentive to dissuade this behavior since the cost is also opaque to them and the threat of malpractice always lingers in the background.
Physician compensation is not the reason that healthcare costs are out of control. Annual healthcare spending is estimated to be $2.7 Trillion. There are many parties uninvolved in direct patient care, who have devised ingenious ways to get a share of this limited pot of money. If one considers that the basic relationship in medical care is between one doctor and one patient, and that the physician is responsible for referrals, tests, hospitalization and x-rays, it becomes clear how others could profit by controlling physician behavior and reimbursement. When doctors have less discretion over their decisions, entities that have had a hand in imposing these controls stand to profit, and they currently are. As a result of current regulation and payment policies preventing physicians from competing against hospitals, doctors are often forced to direct patients to these institutions, where costs are often as much as 10X higher for the same services that could have been offered in a physician owned center.
It is easy to be swayed by "experts" who find it quite convenient to make scapegoats of doctors and their compensation; attempting to convince the public that fee-for-service is the problem while using worn out clichés such as "doctors are being paid for sickness instead of wellness". Physician compensation plays a minor role as a driver of escalating healthcare costs. Anyone who suggests otherwise is protecting their own interests and deflecting scrutiny away from the real culprits- the hospitals, the insurance companies, the federal government, and the trial bar.
exactly. draft them all into the army. pay them what we pay enlisted members of the armed forces. call it a day.
what could go wrong?
Frist, founder of HCA isn’t giving away free health care from their facilities unless it is government mandated to recieve Medicare/Medicaid payment. You can bet your bottom dollar. I’m sick of being told what to do by elite pos.
Oops - I forget - they will be exempted from Obamacare (but then all the good docs will retire and they'll still be in the same boat).
AS IF, ANYTHING the US government has a sterling track record at delivering ANYTHING in a way that is timely, efficient or cost effective!!!
Flip this on its head and ask back -
Why would anyone become a healthcare provider if they can just go on welfare for a better return on effort?
100% of ones wage taken is slavery. At what percentage does it become freedom?
Despite health care costs exploding as a physician we have not seen ANY increase in reimbursement for years.
I appreciate the thesis of the article. After all, if healthcare is a right, then physicians can be forced to provide care for free, just like I can be forced to give up my paycheck to pay for someone else’s care.
There’s not enough discussion of what rights really are when the GOP opposes Obamacare.
When your child needs brain surgery, your spine needs to be rebuilt, your mother’s faltering heart needs to be stopped and reconstructed - who wants to go with the lowest bidder?
“Dr.” Frist, you seem to believe that your fellow doctors are enriching themselves much too much.
Do you believe that a steroid product that has just signed a $22,000,000 5 year contract is “self-eniching?”
Do you think a plastic bosomed Hollywood type is worth $3,500,000 for the making of a single movie?
Do you think the CEO of the insurance company that governs doctor’s payments is really worth that $1,500,000 per year.
I really do not have to ask those question, I know the answers already
To be frank, I truly question and doubt your sense of values.
“Theres not enough discussion of what rights really are when the GOP opposes Obamacare.”
So, what are they?
Controlling doctors' fees and their methods of treatment, and thereby thoroughly bureaucratizing the field, ultimately make medicine unattractive as a profession and deter talented individuals from entering it.Cutting their fees is a good way to cut the supply of doctors just when the demand for their services are increasing. Smart move. Not.
Communists want doctors to get 3-4 times the pay of janitors. Just like in the soviet union. Look it up.
“Elimination of fee-for-servive healthcare within 5 years”?
I disagree that you can be forced to give up your paycheck. Part of it yes, but an entire paycheck? I seriously question that
What should the communists pay be? The ones that say doctors should be paid 3-4 times the pay of janitors?
Well, a right can’t require anything from anyone else other than they not infringe upon yours. Nothing anyone claims as a right can require property or labor from another.
As my tagline says, socialism is slavery.
One thing I learned last year when I had surgery for cancer is that the doctor makes relative peanuts on the deal.
In my case about $3500 out of $65,000 total bill.
Frankly I was quite surprised.
So doctors could work for free without making a large impact on the total cost, at least in that case.
Can’t wait. Soon there will be all union staff in the health care system! How cool is that?
(Until the system crushes itself under it’s own weight.)
About 20% of nurses are unionized already. I’m sure this will increase fairly quickly in non RTW states because nursing will be one of the areas that gets pressured under BaraqqiCare.
Frist sold out conservative principles years ago....This group of nattering nabobs delude themselves and provide fodder for the ‘single payer’ nightmare of Europe and the Soviet Union (oops I mean Russia).
We must fight back hard against this type of nonsense. We waited too long on O care and are now trying to catch up
“Well, a right cant require anything from anyone else other than they not infringe upon yours. Nothing anyone claims as a right can require property or labor from another.”
What about a contract right? If I have a contract with someone do I not have the right due to the contract to require property or labor from them according to the terms of the contract?
What about property rights? If your personal property in the form of a cow strays onto my real property, do I not have the right due to my real property ownership to require you to put forth the labor to remove the cow from my real property? Or, do I not have the right due to my real property ownership to take your personal property, the cow, for my own?
I understand your exact use of language.
I agree with you.
If we allow them to take some of our paycheck, what stops them from taking it all? It's a question of magnitude... the basic premise is that they are already deciding what we get to keep. If we accept that premise, we have to accept when they decide it should be nothing.
Great question. It is not a binary step function. The greater the level of taxation the greater the servitude.
In the first case, you entered into a contract voluntarily. In the second case, your rights were violated. Presumably, the offender would be given due process before being deprived of life liberty or property. More than likely, s/he would voluntarily take care of the problem so it doesn’t come to that.
To say this is the creme de la creme of elitists would be understating the extremely obvious.
“In the first case, you entered into a contract voluntarily.”
I’ll take that as a “Yes, I have the right due to the contract to require property or labor from them according to the terms of the contract”.
But I think that, at least in part, negates the statement “Well, a right cant require anything from anyone else other than they not infringe upon yours. Nothing anyone claims as a right can require property or labor from another”.
I have to step out for awhile. Maybe I’ll address the rest of the post later. Maybe.
If Congress has authority to establish a minimum wage for certain classes of employment, it certainly has authority to establish a maximum wage.
Why not just establish a maximum wage of, say, $50/hour for the entire healthcare industry?
Fewer and fewer people will want to engage on the supply side of this industry, and shortages will naturally occur. However, healthcare is unlike other industries in that current shortages are automatically resolved by unsatisfied market demand: that is, patients die off. Voila! Herein lies the ultimate solution to the entitlements problems.
This same argument should apply to politicians, police, fire and all government workers.
“Out with the old doctors. In with the new!” - Stalin
Kind of like the only way we’ve been able to talk about reining in the government is the sequester.
What happened to sequestergeddon anyway? Weren’t we all supposed to die by now of lack of government? Did they forget to do it?
There is your problem, right there. My husband was in private practice and is now in academia, Those who have never been in private practice have no clue where the money in their paychecks come from, at least the liberals, and they are in the majority. During the Hillarycare debacle one of his colleagues was on her task force. He described this person as a trust fund baby who felt entitled and was clueless to the realities of reimbursement. Just the type of person Hillary would deem an expert.
No, it’s not a yes, lol. You have a “right” to someones services because they agreed to it! That is a simple concept. You do not have a right to their services because you claim a right to health care.
It negates no statement I’ve made. In case it wasn’t obvious to you, we’re talking about intrinsic, natural rights. You have no intrinsic right to the fruits of my labor, unless I hand that over to you of my own free will. It’s not complicated!
"From each according to his ability...to each according to his needs."
Why should doctors "need" to live a better lifestyle than anybody else?
It was called the Kremlin ration. It was paid in special, non-inflated rubles linked to gold. And it carried with it the right to shop in special shops that carried goods unavailable to your average Rooskie.
Leonid Brezhnev's mother was still alive when he assumed the top job in the Soviet Union. This gave rise to a joke in which she visits her son:
"This is my house," said Brezhnev, showing her around. "And this is my car. And that's my swimming pool. And this" he shows her some photographs "is my second house. And this is my aeroplane. And this is my villa on the Black Sea. And this is my yacht!" His mother gasps in wonder.
"You do live well, Lyonechka," she says. "But I am nervous for you. What if the Bolsheviks come back?"
So I answered your questions honestly. I have a few for you. This will help me understand whether we’re splitting hairs or are on the same page. Do individuals possess a right to health care? How about a right to education? Do individuals possess a right to food and water?
Many leftists accept, in the abstract, the notion that scarce resources should be allocated to those who need them the most. What they (and all too many Republicans) fail to grasp is that not only does a person's willingness to pay for something correlate very strongly with need, but it is far less corruptible than other metrics. Those who outbid everyone else for scarce resources get the resources, but have to pay for them. Those who don't bid high enough to get the resources are compensated by not having to pay for them, and will consequently have more money with which they can bid on other things.
Allocating things based upon willingness to pay thus gives people a major incentive to minimize their need for scarce resource. Conversely, many other allocation methods reward those who try to maximize their real or apparent needs. Policies which reward need will beget more need, to the point that demands become insatiable. Only if policies reward those who minimize need, can needs possibly be met.
either pay your way in life or lie down and die!!!
No one owes anyone anything!
Hey Holly, some people think you make too much money!
In case it wasnt obvious to you, were talking about intrinsic, natural rights.
You didnt limit your statements to intrinsic, natural rights in either Post 9 or Post 20, so I had no reason or obligation to limit my response to that. That you find it necessary to make the distinction of intrinsic, natural rights indicates that there are other kinds of rights. Note that Websters 1828 Dictionary states: Rights are natural, civil, political, religious, personal, and public. I would say legal rights and contract rights are included.
And you did write Theres not enough discussion of what rights really are . I dont see how we can discuss that without discussing the various kinds of rights.
You have a right to someones services because they agreed to it! That is a simple concept.
Putting quotes around the word right as you did implies its not really a right, but it may well be a right. Its not an intrinsic or a natural right, but it may be some other kind of right.
You do not have a right to their services because you claim a right to health care.
You might have some type of right, if your claim is a just claim.
It negates no statement Ive made.
Ill stand by my previous statement in regard to your previous statement.
By the way, does a newborn baby have any sort of right to care (provision of sustenance, health care, etc.) from the parents, or can the parents claim the newborn has no right of any kind to anything from them?
And now, to your Post 41, after a bit.
Individuals do not possess a natural right to health care, except maybe in so far as they can provide it themselves. Except maybe a newborn child. A newborn child may have a natural right to health care from its parents. Or maybe not. Maybe the parents can just let the newborn die because it has no right to healthcare from them.
Given that there are rights other than natural rights, individuals may have some kind of right to health care other than a natural right. Arguably if an individual pays for health care in advance, the individual has a right to that health care. Arguably an individual in the US Military has a right to the health care services the military provides its members as part of the deal.
How about a right to education?
I suppose individuals have a natural right to education they can provide themselves as long as such provision doesnt abrogate anothers rights. Again, given that there are rights other than natural rights, individuals may have some kind of right to education other than a natural right.
Do individuals possess a right to food and water?
John Locke wrote: The earth, and all that is therein, is given to men for the support and comfort of their being. And tho' all the fruits it naturally produces, and beasts it feeds, belong to mankind in common, as they are produced by the spontaneous hand of nature; and no body has originally a private dominion, exclusive of the rest of mankind, in any of them, as they are thus in their natural state: yet being given for the use of men, there must of necessity be a means to appropriate them some way or other, before they can be of any use, or at all beneficial to any particular man. (Emphasis added.) He goes on to describe how a man may make such things his own property.
Locke further writes: It will perhaps be objected to this, that if gathering the acorns, or other fruits of the earth, &c. makes a right to them, then any one may ingross as much as he will. To which I answer, Not so. The same law of nature, that does by this means give us property, does also bound that property too. God has given us all things richly, 1 Tim. vi. 12. is the voice of reason confirmed by inspiration. But how far has he given it us? To enjoy. As much as any one can make use of to any advantage of life before it spoils, so much he may by his Labour fix a property in: whatever is beyond this, is more than his share, and belongs to others. (Emphasis added.)
Considering the above, I would have to say that an individual does possess a right to food and water in so far as he can make them his own and that another individual does not necessarily possess a right to amass all the available food and water to the detriment of the first individual, at least absent an organized society. A question would be: Does an individual in an organized society lose this right and if so at what point?
Other questions might be:
Does a prisoner have a right to food and water or may he be justly starved to death?
Does a newborn have a right to food and water or may it be allowed to die without?
Given several property owners along a stream of water, can someone upstream rightfully divert the stream for his own purposes or do those downstream have a right to the water?
Discussion of "what rights really are" is not as simple as it might seem.
I appreciate the time you took to respond.
What you’ve done is show that discussion of rights really is as simple as I claim.
I see your answers to my three questions were “no”, even though I can tell you did not want to admit that. One of the first things I said was that one can do what one pleases as long as it doesn’t infringe upon the rights of others. That is not the same thing as you have the “right to pursue education”. It means no one has the right to stop you from doing so.
Why did I assume this was a discussion of natural rights? This thread was dedicated to health care. Absent man-made agreements, natural rights are the only one at play when it comes to healthcare. Otherwise, it’s between you and the mutually consenting party. Every edge case you presume to use is based on a mutual agreement between two consenting parties.
The rights you seem to be fond of are all man-made, and can be revoked by man.