Physician Heal Thyself

In the early 1970's I recall a speaker at one of our PreMed/PreDent Society meetings in college. A physician from Dallas had a warning for we future doctors. He strongly admonished us not to sign contracts with private insurance companies (pre-dates HMO's) or Medicare/Medicaid, not to accept payment from these plans but only direct cash payments from the patients and not to allow these plans to set our fees or demand discounts. We should certainly provide billing statements for the patient to get reimbursed from their insurance providers and for big bills allow them to collect first and then pay us. But our fee is our fee and whatever they can get reimbursed from their insurance plan is what they get. The contract is between the plan and the patient, not the doctor. The physicians should not be parties to insurance payment contracts with patients. Boy was he right! Sadly, because health insurance became tied to employment without the option of portability or the ability to buy across state lines or the ability of small groups to band together to buy cheaper policies; large insurance companies began going to large employers, signing up their huge workforce and then going to doctors demanding contracts with them for discounts and set fees in order for the doctor to keep his patients and the patient to keep their doctor. Nothing more than high-tone extortion of the doctors by the insurance companies. During that time period the American Medical Association represented about 70% of U.S. physicians but was totally ineffective in heading off this bastardization of the physician-patient relationship. It was during this same time that MediCare instituted Diagnosis Related Groups (DRG's) which dictated to doctors and hospitals how they could treat patients for various afflictions and how long they could be kept in the hospital. Again, the A.M.A. was unable to avert this train wreck. This heralded the decline of the influence of the A.M.A. as its leadership was taken over more and more by leftists in bed with the government. Membership began to bleed off to the point today where only about 17% of U.S. physicians belong. Yet the media and government love to run to the 'doctor's union' anytime they want to report what doctors think about this or that. Pure poppycock. It is now a toothless tiger. The fact that virtually all physicians are under contract with myriad insurance plans and with Medicare/Medicaid, that their fees are set by these entities, that they must accept discounted fees to be allowed onto the plans and that many practices are actually owned outright by the plans thus making the physicians merely employees or contractors has totally perverted the cost/price/value equation beyond recognition. This is one factor responsible for ballooning health care costs; the separation of the provider from the consumer in the payment of fees for services rendered. Doctors don't know how much stuff costs and neither do the patients. People don't know if they're getting a good deal or not. All the doctor knows is that many times he has to argue with some non-physician to get a test done. If the doctor and patient know exactly what everything costs they can sit down and discuss the treatment plan and various options that provide the best care for the best price. Giving the patient more choices in the health insurance marketplace by allowing portability from the severing of health insurance from employment, allowing insurance companies to sell across state lines and allowing small groups to band together and buy better priced large policies would be a good start in bringing down the cost of health care and health insurance and making it available to a larger segment of society. In addition, getting the doctors out of the insurance picture by ending physician contracting and fee setting, having doctors be paid directly by the patients who then get reimbursed by their insurance plan at whatever rate they have agreed to would help the cause as well. Also, let individuals set up medical savings accounts similar to their IRA's. Finally, rational tort reform and scaling back onerous taxes and regulations on pharmaceutical and medical equipment manufacturers would complete the reform picture.