A gentleman named Michael F. Cannon offered this response to my recent comments about HSAs. Mr. Cannon works at the Cato Institute and obviously has devoted a lot of time and thought to Health Savings Accounts. His viewpoints are well thought out and worth reviewing.
As I have tried to emphasize before, I am not morally opposed to HSAs. I just do not think they will improve health care in the United States. But as a doctor, I am above all an empiricist, and so I am willing to let the facts prove me wrong. I do not think they will, though.
There is one point Mr. Cannon makes I have to take issue with: He suggests that primary care medicine may not be cost effective. He sites an article in the New York Times as his only evidence. This article, which discusses research I am well aware of, says that annual medical checkups may be a waste of money.
I have never been an advocate of the annual physical, especially in healthy adults. The only routine testing a healthy young adult needs is occasional blood pressure measurement, a cholesterol check, and, for women. a Pap smear. Obviously none of these screenings necessarily require a primary care doctor -- a nurse may be sufficient. No, the annual physical is not the reason to have a primary care doctor.
Primary care doctors are needed because medicine is getting more and more complicated, and specialists are becoming more and more compartmentalized. A primary care doctor is like a financial advisor -- he is someone who can help you navigate all your options efficiently. Most people do not need to see a financial advisior every year (though some do), but having someone on hand who can help you identify your needs at key times is very important.
Everyone complains that health care is getting increasingly expensive. What is more cost effective if you have more than one medical problem, say, diabetes and high blood pressure, and you develop poison ivy -- to go to an endocrinologist, a cardiologist, and a dermatologist, or to go to a single doctor who can handle all three? Doctors who can address multiple medical problems at one office visit will certainly be more valuable to health cost control than those who specialize and are thus unable to address more than one thing.
It is also worth noting that PCPs are able to provide a lost art in medicine -- watchful waiting. Sometimes the best way to handle a medical problem is to observe it rather than take aggressive action. Treatment can be worse than the disease. Primary docs charge half or less of what specialists do and thus are in a position to perform serial evaluations of patients and look for changes in a patient's medical condition that warrant further workup.
It used to be that observation was one of the mainstays of medicine. Now everything is scanned, biopsied, and aggressively worked up because specialists find it easier to bill for expensive procedures than for recurring office visits. This shift away from observation towards aggression runs the risk of hurting patients, and is one of the casualties of the microspecialist system.