Kevin, MD comments on the state of health care in this country. He says "we can't have everything," which I take to mean that he feels the American public wants high quality healthcare but is unwilling to pay the price tag. All of the commentators on his site seem to agree with him wholeheartedly, and think that patients need to pay more and shoulder more of the burden of healthcare. I respectfully disagree.
I have been a doctor for 8 years now and I know I am in the minority when it comes to healthcare reform. In a previous post about HSAs I spelled out my position. Here I will emphasize a few points. First, all workers already do pay the full bill for their health care. Health insurance premiums are deducted from paychecks, and employers who offer health insurance factor in the cost of healthcare when they set the salaries of their employees. It has been proven in multiple economic studies that companies that offer health insurance pay lower salaries than comparable companies that don't. No one should think for a second that the typical worker gives up nothing for health insurance. Anyone who thinks employees get a free ride on insurance should confront a worker and tell them that.
Take nurses. In a typical hospital, there are two types of nurses, staff employees and agency nurses. Agency nurses work for a nurse staffing agency that leases their services out on an hourly basis. Agency nurses are not hospital employees, and are paid strictly on an up-front cash basis, one shift at a time. They are essentially independent contractors, and are paid much more money per hour than staff nurses -- sometimes $10 an hour above staff nurses, or even more. Yet every staff nursem, if asked, will tell you that she chooses full-time employee status over the better money of agency nursing because she wants the benefits. She knows exactly how much money she is giving up in the trade. Yet most nurses choose staff-employment over agency nursing.
But the key point I want to make is that when it comes to health care reform, doctors are not often very consistent in their opinions. The typical doctor (such as those posting in Kevin, MD, and the site Kevin was quoting, Medpundit) is completely against nationalized health care. I know very few doctors who want the government to finance insurance for everyone. And yet . . . .
If you look at the activities of the AMA, you will find that one of the AMAs highest priorities is lobbying Congress for increased Medicare funding. Each year, Congress tries to cut reimbursement to doctors under Medicare. And every year, doctors furiously lobby Congress to get the cuts restored. I have never met a doctor in my life who thinks physician reimbursement under Medicare should be reduced.
Think about it. If doctors really and truly believe that big government is bad, shouldn't they be lobbying for a smaller Medicare? Shouldn't they be arguing the Medicare should be cancelled, and that Medicare patients should be forced to pay cash for their care? In Kevin, MDs blog entry, he quotes Washington Post columnist Robert Samuelson: "Medicare recipients should pay more of their bills." That means Samuelson, and presumably Dr. Kevin and Medpundit, want Congress to cut Medicare payments to doctors. That is exactly what they are saying. I know of no way to make patients pay more of their bill except to cut the Medicare payment.
That is the paradoxical attitude of many doctors have towards health care reform. On one hand, they are against government involvement in health care. On the other, they are against any cut in physican reimbursement. Since Medicare is a government program, they are both in favor of and against the growth of Medicare growth of Medicare payments.
If the doctors who support shifting more financial burden directly onto patients get their way, there will be fewer patients who can afford to go to the doctor. This is economics 101. When you raise the price of something, fewer people will be able to afford it. Demand goes down. In the end, this so-called beneficial shift will save taxpayers money, but it will also deny health care to millions of seniors. And yet, check the AMA website, even as some doctors push to decrease government payments for their patients, they are working at this very moment to increase government payments to themselves.
I want to say parenthetically that I do not oppose the AMA's efforts to increase Medicare physician payments. But then, I am not the one calling for decreased government involvement in health care.
Conservatives often make good points when they argue that private businesses can provide services cheaper and more efficiently than the government. But in the case of health care, I do not believe it is so. Private enterprise has had every opportunity in the world to provide cheap, efficient health care. What we have as a result is millions of uninsured, millions more unhappy with the insurance they have, and the medical community arguing that public health spending needs to be cut for the patient's own good.
I ask you: Is your health care cheap? Is it efficient? Do you trust it to be there for you for the rest of your life?