Behind the very public calls for universal health care to be The One True Solution to the American health care crisis, and my own Cassandra-like observations that underlying inflationary patterns are being ignored, some folks have pointed out that another piece of the puzzle might be found by looking at how medical professionals are compensated.
Oversimplifying, compensation seems to be driven by how many “things” a care provider does, multiplied by the relative trendiness of those things. That math appears to be driven in part by ripples from Medicare reimbursement schedules. And, if those schedules are prescribed by bureaucracy, rather than emerging out of free market forces, a logical consequence is that you’ll find more medical professionals interested in doing a lot of trendy things, while professionals working in a more mundane mode will see their income suffer.
This concept, I have to admit, I hadn’t really thought much about. But, a recent Wall Street Journal article (subscriber link) has started to remedy that. Quoting from the article:
A discipline built on spending time with patients to gather clues for a diagnosis, neuro-ophthalmology could become another casualty of a medical payment system that favors high-tech procedures over low-tech exams. The median income of a neuro-ophthalmologist at a teaching hospital is $200,000, according to the North American Neuro-Ophthalmology Society. That’s a third less than most general ophthalmologists, who undergo less training but can see more patients, and do more pricey procedures, in a given day.
Many in health-policy circles have focused on how the current health-care payment system is helping create shortages among primary-care doctors, internists and others on the front lines of medicine. But often lost is how the system is endangering some of the country’s most highly trained specialties as well.
Endocrinologists, rheumatologists and pulmonologists — specialties that also don’t involve performing many procedures — face acute shortages. Many of the severest deficits affect children. Though nearly 300,000 children in the U.S. are diagnosed annually with juvenile arthritis, lupus or other complex rheumatic diseases, there are fewer than 200 pediatric rheumatologists to take care of them, according to the U.S. government’s Health Resources and Services Administration.[...]
For two years, 68-year-old Al Purdon says he searched for a diagnosis for his persistently drooping eyelid. A visit to an optometrist led to a referral to an ophthalmologist and six more doctors, including an endocrinologist and a plastic surgeon. (Optometrists complete a four-year postgraduate program; ophthalmologists have a medical degree.) Several scans, a surgery and a biopsy later, Mr. Purdon says his eye still drooped, his Medicare had spent $10,850 on bills and there was no diagnosis.
Frustrated, Mr. Purdon and his wife went in early 2007 to Dr. Frohman. Dr. Frohman “took one look and said, ‘I think I know what it is,’” Mr. Purdon’s wife, Johannah, says. A series of seemingly basic tests, some questions and a blood sample later, Dr. Frohman diagnosed Mr. Purdon with myasthenia gravis, an auto-immune condition that impedes signal transmission from nerves to muscles throughout the body, but often first in the eyes. Medicare paid $220 for the visit, and Dr. Frohman said he’d continue to monitor the condition.
Mr. Purdon’s prior treatments may pose another risk. Because myasthenia can go into remission, doctors say the eye-lid surgery Mr. Purdon had can sometimes overcorrect the lids and make them appear to bulge.
The subject resonates with me in no small part because of what my wife’s been through in the past several years. Folks who have read my writing are probably aware that she was in a car accident and suffered a freak brain injury. However, because of the interrelationship of her symptoms, aggravated by limitations on her ability to communicate, it took us a couple of years to find a doctor willing to sit and take the time to start peeling back what all was going on with my wife until a couple of years later we actually got fairly robust set of diagnoses.
You know, there is something rather intoxicating about living in a society that is exciting, fast-paced, and highly reactive. Something happens, and we quickly react to it, and hurry on to the next development.
However, there is something to be said for stopping, looking at the environment around us, and taking the time to really contemplate the complexities of what is going on, thereby hopefully gaining better understanding of what is happening. That is a shame, because reacting without understanding can introduce inefficiencies, or undesirable unintended consequences.
One of my biggest fears about our seeming rush to universal health care is that it seems to me to be a “solution” prescribed without understanding the full problem. Moving more people into a system where professionals have an incentive to react, rather than to diagnose and to fix, would likely aggravate some of the health care issues the country faces.
I’m enough of a social liberal that I love the idea of ensuring that everyone has access to a basic level of healthcare. But unless some of the inefficiencies and inflationary pressures are addressed, and until there’s been a good, honest public discussion over the pros and cons of different levels of universal care versus the costs associated with that care…the path political inertia seems to be moving us down is going to have a very ugly fiscal surprise waiting for us around the next bend.