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The Problem With Doctors

My colleague Greg Sargent has a nice catch from the latest Gallup poll. The survey asked respondents how much they trusted various actor in the health-care debate. Doctors fared pretty well. So too did health researchers and hospitals. Obama is trusted. Insurers and pharmaceutical corporations, however, aren't. In fact, the only group less trusted than insurers and pharma are...Republican legislators:


You might want to remember that next time Sen. Judd Gregg explains what the American people want. But I'd also urge you to focus on the left half of the poll: One of the real difficulties in health care reform is that 71 percent of Americans think doctors are pretty much beyond reproach.

This is, in a sense, a psychologically important opinion. When we enter a doctor's office, we are generally in pretty bad shape ourselves. We're sick, and we don't know what to do. We're asking someone to tell us. And we don't have the expertise or energy to wonder whether every recommendations is based on firm scientific guidelines or totally disconnected from questions of profit.

But doctor behavior, though generally admirable, is certainly not perfect. We're still in a world, sadly, where study after study shows that the treatment we should get does not match the treatment we do get, where study after study shows that the treatments we do get are often not based on sufficient evidence. There are certain policies -- things like comparative effectiveness review, or a reform of fee-for-service payment practices -- that would improve the situation. But it's hard for legislators to broach those subjects because doctors are a popular, and thus a powerful, constituency, and they reflexively oppose policies that could harm their salaries or limit their autonomy.

I'd say a lot more on this, but Steve Pearlstein pretty much wrote up my thoughts in his column today. So just read that.

By Ezra Klein  |  June 17, 2009; 2:08 PM ET
Categories:  Health Reform  
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The AMA is the most conservative wing of physicians.
And yet they've made universal coverage the primary plank of their platform. And they support comparative effectiveness as long as it is only used to give physicians and patients more information, and not force your hand in making treatment decisions (I mean, who do you think is going to run the comparative effectiveness research).
On fee-for-service, I think the medical community is relatively divided. Most physicians like the concept of medical homes and changing payment structure, with only some specialists concerned they'll lose their huge incomes.
So what's the problem? They're in full agreement on the access side of reform, they're on board with 50% of the agenda on the cost side.
Pretty progressive, no?

Posted by: CarlosXL | June 17, 2009 2:42 PM | Report abuse

You seem to be making a new friend Ezra. Seriously though, good stuff.

Posted by: Castorp1 | June 17, 2009 3:13 PM | Report abuse

I do note that the Gallup survey failed to asses the public's impression of the value of advice from op-ed columnists for reforming the health care system. Just coincidence or too embarassing?

Posted by: desertsage | June 17, 2009 4:28 PM | Report abuse

And Democrats in Congress are only two slim points ahead of Pharmaceutical Companies. Yikes.

Posted by: jeirvine | June 17, 2009 4:44 PM | Report abuse

France, Canada, Japan, Germany, just to name a few countries, all manage to contain costs much better than we do, but still substantially utilize fee-for-service payment.

And if iirc, the doctors in France have a great deal of autonomy [ie, the insurer pays the bills without dictating what tests or treatment the doctors can provide] and in Canada, percentage-wise, many more doctors are in small group or solo practices than we have here.

These people all live longer, healthier lives than we do and pay less money than we do because their governments impose price controls on health care goods and services [and on insurance, if people are required to buy it] and doctors spend their time practicing medicine instead of haggling with insurance companies or ticking off little boxes on P4P forms.

As for harming their salaries, has there been a reliable poll on this? Anecdotal evidence suggests that plenty of doctors would happily take a 20% cut in income if it meant no more insurance companies to deal with.

Posted by: hipparchia | June 17, 2009 9:02 PM | Report abuse

Increase the reimbursement for office visits and decrease the reimbursement for tests etc.
Docs can't make the income they want on office visits so they either churn and burn or test and refer. Change the incentives and you should have a different outcome.
Some patients are partly to blame since they demand the complete work up whenever they are sick.

Posted by: PMuldoon | June 18, 2009 12:18 AM | Report abuse

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