Additional taxes on
physicians to reduce excessive medical cost? Yeah, that’s gonna work.
IMO, Physicians are getting a bum rap from people who blame
them for rising medical insurance premiums. Yes, rising physician fees are
among the reasons – but that cannot be the main reason.
First the big picture: physician charges, primary and
specialists together, are + / - 30% of total national medical care spending. (In the employer medical benefit plan I
once managed, physicians’ charges amounted to 37% of our total yearly
cost). To blame rising premiums on
a single component equal to 30% of the total medical spending is clearly wrong.
It’s true that insurance premiums rise because per capita
medical costs rise. So the right
question is much broader: Why do medical costs rise?
I believe there are four main reasons:
1. Aging
population
Older populations have more chronic conditions that are more
expensive to treat than conditions prevalent in a younger population. (I assume everyone agrees that a
“Soylent Green” strategy is no solution).
2. Impact of
technology
Modern innovations in medical care have generally been more expensive. (I assume everyone also agrees
atorvastatin should remain on the market, along with MRI’s, laser surgery, and the multitude
of examples of modern medical care that have value - not simply cost).
3. Consumption of a more expensive mix of services year by year
A more expensive mix of services each year means the overall cost of
medical care rises, even if not one physician raised her fees. I almost never see this factor mentioned.
(a) growth in the ratio of specialists to total
physicians
(b) evolution of more costly medical specialties (e.g., diagnostic radiology), driven by technology
(c)
“downstream” impact on hospitals that must support the new kinds of
treatments including necessary equipment/devices.
4.
Overinsurance - insurance that reimburses medical expenses virtually in
full.
Medical professionals and institutions whose patients have
their fees paid virtually in full have no incentive to find ways to reduce
them. And patients
have no reason to care, or ask, if there may be perfectly adequate treatment alternatives that are
less costly.
Are American policy decisions based on correct diagnosis of
the problems we face? For example,
can anyone demonstrate whether Americans consumed too much care in 2009 or
whether we consumed too little in 1980? Why has the emergence of newer, super-specialty treatment not
reduced the trend in total cost? What
is the evidence that the growth in specialist care is producing better outcomes
- even for the same cost? How can medical care be delivered in many other
nations with arguably comparable outcomes to the U.S. but at much less
cost? And by the way, if
services are paid essentially in full by a third party - private or government,
doesn’t matter – does it make sense to blame physicians for filling in numbers
on what amounts to a blank check provided by the third-party payers? The answers carry enormous
policy implications. IMO,
the fees that physicians charge for their services are much less significant
than these answers.
Yet America has now been committed to specific “reforms”
that don’t appear to consider, much less answer these questions. Our health policy leaders and pundits
have done a remarkably poor job explaining why. In any case, I suspect that the answers aren’t to be found
in any legislative body that behaves as though higher taxes are the right answer to every problem.
