“I know you’re supposed to push me on these. I know they’re a money-maker for you, but I just won’t do that pneumonia shot.”
She had been my patient for years and was in her 70s with severe lung disease, but she was still under the assumption that I personally profited somehow from encouraging her to get a lifesaving vaccine. This has become an increasingly common reality since trust in physicians has declined and highlights one of the harms that come with casting physicians as the enemy when it comes to our for-profit health care system.
Regarding Michael Millenson’s op-ed “Abuses by doctors and hospitals led to health insurers’ clout over coverage” (Dec. 22), there are certainly bad physicians out there, and scrutinizing overbilling is important, but data shows physician fraud is actually quite rare. And while physician salaries are a seemingly easy target, especially at a time when the cost of living is surging, the data does not support the claim that provider salaries and billing practices are the primary driver of surging health care costs. The real threat to American health care is not those on the front lines.
In recent years, private insurers have billed Medicare billions of dollars in excess, finding loopholes to help them garner more and more revenue from taxpayers. And while insurers in America have earned themselves hundreds of billions of dollars in profits over the past decade, they have put increased cost burdens on patients and demanded that doctors do more and more to justify medical decision-making.
There are days when one of our nurses has time for nothing else besides filling out paperwork justifying cancer scans for patients. There are days when one of us works late just taking phone calls with insurance teams because they don’t think the medical decision-making was good enough, even though they’ve never met these patients.
The executives of pharmaceutical companies and private equity firms never took the oath to “do no harm” — an oath that might seem trivial on the surface but that anchors many of us to the work of patient care. And while regulations of physician salaries and billing practices are surely necessary, let’s not divert our energy pointing fingers at patient allies.
We promise that physicians are angry and exhausted and heartbroken too.
— Dr. Monica Maalouf, associate professor of medicine, and Dr. Sydney Doe, Oak Park
Regulations in health care
The op-ed by Michael Millenson highlights an important concept that we all would be wise to consider during the rush to discard regulations in the name of freeing up capitalism.
People hold doctors in high esteem for many reasons. They have deep knowledge in their fields, the benefit of a long education and training process. But it is clear that the elite medical class contains a wide variety of opinions about what constitutes their obligation to “do no harm” in tandem with their expectations about the income they feel entitled to earn.
I’ve been in the property and casualty insurance business for 44 years. The intersection of health care cost and workers’ compensation is where I have viewed this most of that time. There are doctors who want to help patients get back to work, and there are doctors who want to help the patient milk the system if they can also benefit by unnecessary procedures.
The concept that I think this illustrates is that there are always going to be people who put their own interests before those they ostensibly are paid to serve. This is the key human flaw in social groups. It is also the reason to have a government empowered to regulate all business — to protect consumers and capitalism from these abuses.
So, it worries me and many others when Elon Musk and Vivek Ramaswamy talk about the dismantlement of the regulatory state. It is obvious that regulations add a cost and time burden to those who are regulated. There is also the problem of regulatory capture, in which lobbyists pour so much money into the political system that they control the applicability of regulations through what is essentially legal bribery.
But neither of these is a good enough reason to allow capitalism to dictate how we get medical care and many other services without outside oversight by the government.
I agree that our regulatory system needs a disciplined overhaul that uses discernment to lower cost burdens without gutting the protections that are necessary. The court system is not enough to protect consumers from unfettered profit-seeking. And the use of that system adds unnecessary cost for the consumer that rightly should be borne by all citizens and not just the already damaged consumer.
— Rich Ramlow, Wilmette
Improve quality of care
In his op-ed, Michael Millenson argues that it is doctor and hospital greed that burdens patients with unnecessary costs and the insurance industry with a gate-keeper function.
He lashes out at the financially self-serving ways some health care providers recommend medical services to their patients. I would argue that human beings are programmed to pursue their own self-interest, often subconsciously, whether we like it or not. Even doctors. What rational restaurant owner would ask patrons to leave their payment for their food in an unmonitored cash register? The “honor system” doesn’t work, even with people who don’t typically engage in criminal behavior.
The treatment excesses Millenson points to are a byproduct of crony capitalism in which some of the market forces generated by a profit motive are artificially manipulated while others remain intact, creating winners and losers. We need to embrace rather than eschew the profit motive as a driver of efficiency and not rest our hopes for reform in a system that is in conflict with human nature.
To improve the quality and cost of health care, we need to:
- Embrace the “veterinary ethic” in which the overriding goal is quality of life and wellness rather than fighting death. (Studies show a large percentage of individuals’ overall health care costs are incurred in the last six months of life.) We show more compassion for our pets when we choose to withhold medical intervention at the end of their lives because it would only extend their misery.
- Address the medical training bottlenecks that limit the number of physicians we can produce. We need many more physicians to be able to fill service gaps and generate competition, likely leading to improved services and lower costs.
- Empower patients to have financial skin in the game. This is crucial if we are to have an efficient and affordable health care system. It would make the doctor and patient genuine partners in deciding whether a particular test or treatment is truly needed. For those who can’t afford health care, we need creative government programs such as medical vouchers, medical school scholarships in exchange for caring for the indigent post-training, expanded Veterans Affairs services, etc. No one should have to go without quality health care.
- Codify full price and quality metrics transparency. All of the above interventions depend on this.
— Dr. S. David Field, Highland Park
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