I’m in my hotel in Salt Lake City (a beautiful place) checking out what fellow bloggers are talking about, and hop over to Over My Med Body to see what Graham is up to. One of his recent posts is about the difference in health care costs in the US and Canada, wherein Graham notes the Canadians are spending about $900 less per person than we are, funds which could go to higher wages, etc.
In the comments section, a physician moans about the problems with rationing inherent up North, and states that no red-blooded American would put up with that, while placing most of the blame for our exorbitant health care costs squarely upon defensiivce medicine.
Which inspired the following rant.
If I hear one more doc complaining about defensive medicine and tort costs I’ll throw them under the wheels of their golf cart. Care is rationed in the US – for the 45 million uninsured, for Medicaid recipients, and for those in staff and group model HMOs as well as anyne who has to comply with precert rules.
This rationing argument is nonsense, not only because have de facto rationing but also because it is a red herring. Canadians, Swiss, Norwegians, and citizens of 33 other countries are healthier than Americans, yet we pay about 50% more than they do.
So the good Dr. Thompson et al are delivering an inferior product and charging much more for it.
Finally, what is wrong with rationing of care? The question is NOT how many MRI machines does Canada have compared to Portland, it is what is the right number of MRI machines? And my bet is many of Portland’s MRI machines are owned by docs, who make money by sending patients there, all the while hiding behind the covers of “defensive medicine”.
And this before the morning caffiene…
Apr
5
Good stuff Joe!
Thank you, Joe. I was going to respond to him last night, but I was busy working on a fellowship application. I would’ve written the exact same thing. Minus the golf cart part. That’s hilarious.
You think you two got whining? Did you see this thread on my site?
http://www.thehealthcareblog.com/the_health_care_blog/2006/04/physicians_doct.html
Oh come on, guys.
Joe, maybe you need that cup of coffee.
We all know that physicians use up much less than half of all the money spent on health care, and lots of the money that goes to physicians pays for office over-head, much of it to handle all the paperwork and bureaucratic requirements that Medicare and managed care use to supposedly control costs.
We also know that there are big variations in how much money physicians make, and that most of us in primary care and other “cognitive” specialties don’t make a fortune.
Sure, some physicians make a lot. Sure, some physicians do not live up to their professional ideals.
But it is so easy to bash doctors and blame them for everything that’s wrong with health care.
That sort of thinking has lead to the sort of across the board reimbursement cuts that are driving primary care doctors out of business.
Soon, then, we may see what it’s like to run a health care system without them.
It probably won’t be pretty.
Before that happens, why don’t you good folks stop a minute and think about all the money that goes to hospitals, to drug, device and IT companies, to managed care companies and insurers, and to what Kleinke called fourth, fifth, and sixth parties in health care?
And then think what to do about it.
Wow, Joe. “The Golf Cart”
I think I need to check out Over My Med Body and see what my fellow blogger Graham is up to. I agree the rationing has been going on for years with no end in site! At least for most of us personally and the normal folks with PPOs, HMOs, Medicaid MHPs, Medicare, etc.
Roy – I’m not singling out docs and damning them alone – my blog is full of other accusatory statements about who is to blame for the health care mess.
My point about the doc on Graham’s blog is the nonsense about defensive medicine. That is a canard – it has been shown to be a component of health care costs but by no means the major driver.
And studies indicate that the key difference in health care costs between the US and other OECD countries is price per service.
So, price is too high; docs deliver the care, order the scripts, etc, and then blame defensive medicine.
That blaming is what is in part driving the blunt instrument of price management. IF docs want to avoid that ro deter it, then they need to stop hiding behind it, and focus on why they are worth the money.
I’m all for that discussion.