I had a doctor’s appointment today and took the opportunity to pick my primary care physician’s brain about how he felt about health care reform. Here are the notes of what he said:
- Individuals should be taking more personal responsibility for their health.
- Enough with the wimps who bump their knee and come in demanding an MRI of the bruise.
- Education is the key to reversing the idea of malpractice lawsuits (he didn’t explain or expand on this, so I’m not sure where he’s getting with it)
- Malpractice insurance is THE PRIMARY expense of a primary physician’s practice costs. It could be up to $200,000 a year. Guess who pays for that? Not the physician!
- Technology will be a large cost up front for very little return. The great advantage of computerized medical records is when enough physicians participate, that when you are traveling and have to go to the doctor, he can access your e-records and skip many of the preliminary tests and history gathering. It’s like the conundrum of the first guy who buys a fax machine…
- Primary physicians make their money from simply having patients assigned to them by a given insurance company. That company pays the physician around $10/patient/month regardless if the physician even sees the patient. Treatment is done for the cost of the co-pay and all tests and most procedures are paid for by the medical group, not the physician. So this is similar to the concept of insurance; you get predictable amounts of money flowing in each month and you hope that your expenses do not exceed an amount that affords a profit.
- In Italy, they have basically what the US is pushing for; a combination of private and public health care options. When Italians want something done quickly, they pay for private care. When they want to save money at the expense of waiting, they settle for public care. He has first hand experience of this. What was of particular interest to me was when I asked what their tax rate was like in Italy compared to the US; he said it was comparable.
- In the US, we already provide health care for everyone. It’s called the ER. The ER doesn’t turn people away with half a face missing from an accident, just because they can’t prove residency or ability to pay. But they do pass the cost on to those who CAN pay.
So after hearing his side of the story, I’m back to my original question; what are we trying to fix and what does the fix entail?
The title of H.R. 3200 couldn’t be less clear or more dreamy: “To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes.”
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