doctors making money: the problem

I'm going to be a doctor. It is an incredibly difficult road. I became a doctor because I know it will be a rewarding and interesting career. However, I also became a doctor because I knew it would be a great way to support my future family. In fact I became a doctor because I expected it to support my family quite well actually. Sure, I wouldn't be making as much as the guy who works a successful pyramid scheme or the successful business owner, or the investment banker, or the dentist... in fact this list could go on. But I became a doctor because it's not about the money... but it is just a little bit.

Then I read THIS ARTICLE in the New York Times. It talks about how part of health reform ultimately must control... gulp... physician salaries.

But I can't help but agree with the author. The author is taking from an article written by Dr. Howard Brody, professor of family medicine and director of the Institute for the Medical Humanities at the University of Texas Medical Branch in Galveston wrote for the New England Journal of Medicine. He talks about the way physicians can quickly run up the cost for medical care by utilizing expensive technology like diagnostic imaging.

This reminded me of a conversation I had with a pediatrician yesterday. I asked her "So, how difficult is it to sub-specialize in pediatrics?"

She responded, "It is a little bit competitive for some specialties. But I would advise against it for you. The field of primary care is where the demand is, and specialties are getting too overcrowded."

This was really interesting. Could this be true? Could medicine in the United States turn its back on expensive frivolous treatments and diagnostics?

I don't know. Most people I meet in the United States seem to think it is appalling that people in Canada have a waiting list for elective surgeries and the fact that access to an MRI sometimes is not as simple as showing up to the primary physician with a complaint of dementia.

As much as people complain about medical costs in America... maybe they complain about them the same they complain about Baseball players: many think it is ridiculous that players make that much, but they continue to buy the merchandise and pay $100 for a mid-level seat.

So what's my opinion? I don't want people to pay for unnecessary treatment. It is dishonest. It is like a dentist I had who performed several unnecessary procedures on my family (ie. "I have good news and bad news. The good news is that you didn't need a root canal. The bad news is that I did a root canal."). I didn't go into medicine to be a businessman. But do I think ultimately greedy doctors are the reason medical costs are up?

No. A big no. I think it is what people expect. It is the lawyers who sue doctors who don't do the MRI of the brain. It is the way insurance pays for CT scans and refuses to pay for physiotherapy. It is the way people expect to be lazy and eat high fructose corn syrup while taking insulin. It is the way drug companies are able to advertise direct to consumer just like a breakfast cereal does to kids.

Ultimately, I think it is the desperation we all have to be healthy, pain free, and to extend life as long as possible that allows capitalist structures to ultimately take everything we have monetarily (and then some) to fulfill these lofty promises.

Holy smokes. We need health reform in America.

Canadian Health Care

Health Care Quote

I read a fantastic article about Medicare on NPR. It is basically about how Medicare actually succeeds. This frames my opinion about the Healthcare debate so awesomely well:

"Bernfield says she's not at all worried about claims that the bills now under consideration in Congress might cut back on her Medicare benefits. In fact, she thinks the country would be better off if everyone could have the same Medicare benefits she enjoys.

"I think people don't understand that instead of government in their business, they have health insurance companies in their business," she says. "Somebody is overseeing your health care no matter what your status is. Whether it's to tell you you can have it or you can't have it, somebody is there checking off a box."

I know that insurance has to examine claims to stop fraud. But the profit incentive to deny claims... it sickens me. I hope congress really starts to change things about health care in the United States. Mandated coverage and a public option... it just makes me excited to think about this.

I'm excited about a mandate because it may prevent costly visits to the ER that are paid for by those who actually pay bills / have insurance. Because of a mandate, hopefully we will see more visits to the primary physician to prevent illness and treat disease before it becomes an emergency.

I'm excited about a public option because of its lack of profit incentive and the proven low overhead of government administered health care. That means I'm getting bang for my buck. Plus, Medicare is portable and actually affords extensive coverage. What a dream that a poor student like me can have access to that kind of care... it just makes me happy. And all the people working day after day without health benefits for big companies like WalMart, Target, or small companies like Downeast Outfitters, Cafe Rio, or Yogurt Land -- YOU WILL HAVE GOOD HEALTH CARE IN YOUR REACH!

It just makes me excited! So come on congress! Work together! Bring the great Republican ideas about malpractice, and trimming wasteful government spending (ie. subsidizing drugs at a RIDICULOUS COST). Bring the great Democrat ideas about mandates and a public option! Let's do it!

And to all you lousy, lying, and filthy lobbies, right-wing radio idiots, self-serving politicians, and liberal snobs... stop stirring the pot of contention. Do something useful and actually present both sides of the problem we face in health care! Or better, just go away.

Rationing Health Care: The US does it a lot

In conversations with friends about health care in Canada I often hear, "Well in Canada you have to wait months to get a hip replacement. Right?" No one in my family has had a hip replacement, but I can say when we needed primary care we got it. When my Dad injured his elbow he had an MRI, and the appropriate surgery within a week (and then afterwards got months of physical therapy). And for all this health care we have never had to worry about getting a bill in the mail. Ya, it is pretty awesome!

And before you say we pay for it in taxes, I just want to remind you of a post I had written a long time ago that argued Canadians actually pay quite similar tax percentages. Here's the proof again! These are all taken from Canadian and American federal websites (please click and make the pictures larger).

First Canada, the above numbers the federal tax rates. The second set is the provincial tax rates:


Second, the United States. Here are the Federal Income tax brackets:


And here are the State income tax rates (roughly, since we only see the bottom and top tax bracket. It also shows deductions, but please know that Canadians claim thousands in deductions and credits every year as well):


So there you have it. Tax wise, we are really not much different. However, with what the average middle-class US citizen gets out... don't you feel a little cut short. I mean, no universal form of health care. An essential right, is sold much like any other form of insurance. You mean, there is a company placing bets that you won't or will get sick and charge you the appropriate fees per month.

I'm going to be bold and just say it. Health insurance in America is sickening. Detestable. Gross. Abhorrent.

So back to my original point about rationing. You think this is only a Canadian phenomena. Read THIS.

The NY Times article I linked above talks about health care rationing in United States. Here are some highlights:

Today, I want to try to explain why the case against rationing isn’t really a substantive argument. It’s a clever set of buzzwords that tries to hide the fact that societies must make choices.

In truth, rationing is an inescapable part of economic life. It is the process of allocating scarce resources. Even in the United States, the richest society in human history, we are constantly rationing. We ration spots in good public high schools. We ration lakefront homes. We ration the best cuts of steak and wild-caught salmon.

Health care, I realize, seems as if it should be different. But it isn’t. Already, we cannot afford every form of medical care that we might like. So we ration.

We spend billions of dollars on operations, tests and drugs that haven’t been proved to make people healthier. Yet we have not spent the money to install computerized medical records — and we suffer more medical errors than many other countries.

We underpay primary care doctors, relative to specialists, and they keep us stewing in waiting rooms while they try to see as many patients as possible. We don’t reimburse different specialists for time spent collaborating with one another, and many hard-to-diagnose conditions go untreated. We don’t pay nurses to counsel people on how to improve their diets or remember to take their pills, and manageable cases of diabetes and heart disease become fatal...

Milton Friedman’s beloved line is a good way to frame the issue: There is no such thing as a free lunch. The choice isn’t between rationing and not rationing. It’s between rationing well and rationing badly. Given that the United States devotes far more of its economy to health care than other rich countries, and gets worse results by many measures, it’s hard to argue that we are now rationing very rationally.

The article contains itemized reasons as to why America actually does ration health care. The author is much more balanced then I am on the health care issue, so don't be scared.

Obama & Health Care

The New York times ran an interesting editorial on health care that got me thinking about health care reform again.

First of all, Obama spoke to the AMA today. The reaction was chilly. Obama's proposed changes to malpractice, electronic health records, and anti-smoking legistlation were met warmly. However, the push for health cost savings was met with ice cold stares. So why the resistance from the AMA?

Fortunately, the NY Times expanded on this and provided an explanation. Essentially, health cuts really hurt physician salaries because they get less money for doing the same thing. Does this idea need to be expanded? Probably not.

So what is the solution? I think we need to simplify the system. I think materials and procedures should have a consistent cost and a clear system of billing. Is this possible? If so, it would provide a clearer picture as to how Obama's plan would change things. Because I think right now, everything is just speculation. We don't know how physician compensation would change. We don't know how our costs will change. Everything is a step in the dark.

Hopefully, President Obama will continue to make more steps to inform us about his proposed changes. I will be listening carefully for any numbers that he reports. So if you're interested tune in June 24th for Obama's "Health Care Town Hall" on ABC.