Another Open Door Crashed Through

But, sometimes you need a prestigious panel to lead the way. The report of the National Commission on Physician Payment Reform is here. The highfalutin' name is maybe a little pretentious -- it was convened by the Society of General Internal Medicine, not the gummint. And yes, internists -- primary care docs -- have a lot of skin in this game. But they say all the stuff that needs to be said.

I've been raving about these issues here for years, so I'll take this opportunity to hit a couple of high points that might fit on a bumper sticker, maybe a really big one.

First of all, did you know that the U.S. already spends about as much public money -- taxpayers' money -- per capita on health care as the other rich countries that have universal coverage and better results? It's true -- we spend more than Canada, Switzerland, France, the UK, Australia and many others. Then we spend an approximately equal amount of private money on top of that. As a result our total spending on health care per person is more than twice the average of the other wealthy countries, and by far the highest on earth. And yet we don't provide any health insurance at all to 48 million people. And our population's health status is worse than that of Paraguay.

In other words, if we were as smart as the cheese eating surrender monkeys, we could take the public money we are spending today on health care, and provide excellent health care to everyone, without making anybody pay a single dollar out of pocket. 

Why is that? Basically: we pay more for the same goods and services; we pay for a lot of stuff we'd be better off without; we don't pay enough for stuff we need more of. The fee-for-service payment model creates an incentive to do more, but not to get the best results. We pay much more to certain specialists who do expensive, high technology procedures than we do to primary care doctors who can figure out what we really need, do the cheap stuff early that really matters, and save us from unnecessary or even harmful and very expensive interventions. To whit: a radiologist earns, on average, $315,000 a year, while a primary care physician earns $158,000. No wonder there is a crushing shortage of primary care physicians, and no wonder we get far too many imaging procedures.

All this talk about the unsustainability of Medicare and Medicaid, and how we just have to cut benefits and raise the eligibility age, is either ignorant blather or deliberate lies. We can easily afford high quality care for everyone. But we aren't even having the right discussion.