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Posted at 5:47 PM ET, 03/11/2011

What I’m going to tell the doctors

By Ezra Klein

I’m giving a keynote address at the annual convention of the American Medical Student Association tomorrow morning. I think these will be my talking points:

1) Your organizers should’ve gotten Atul Gawande instead of me. He’s better at this sort of thing.

2) The politics of health-care reform are almost 100 percent about insurers. The success of health-care reform is almost 100 percent about doctors.

3) Attitudes toward doctors range from terrified to awed. Insurers are afraid of them because if doctors begin saying insurers are denying necessary treatments, the backlash, as insurers found in the 1990s, can be tremendous. Same goes for governments. Patients are in awe of them, because they are sick and scared and desperate for the help of anyone who seems to know how to make them better.

4) For that reason, cost control theories that rely on the patient to become more sensitive to costs or the insurers to become more aggressive on costs will fail. The only thing that will work is giving doctors the information and incentives that allow them to practice medicine in a way that controls costs.

5) In the future, either doctors will make less money than they are expecting to make now or there will be fewer of them than we project there will be now (perhaps because there will be more nurse practitioners and MinuteClinics). Politicians don’t like to say this clearly, but it’s true. It has to be true. If it isn’t true, America becomes functionally insolvent and ends up a “Mad Max”-esque dystopia . . . where doctors either make less money than they are expecting to make now or there are fewer of them than we project there to be now.

6) This means one or more of the following things will happen: 1) Doctors will be paid on outcomes, with the curve constructed such that most doctors are making less but the best doctors are making more; 2) doctors will not be the only ones doing doctorlike things; 3) some disruptive innovation, such as IBM’s Watson, will have made various classes of doctors less necessary; 4) we’ll have moved to an all-payer or single-payer system where we’ve cut doctor payments dramatically; 5) more people are flying their jet packs to India for surgeries; 6) we’ll have dramatically cut health-care subsidies such that fewer people are able to afford health care; 7) something I haven’t thought of.

7) We will try No. 1 first, because it’s better to cut “unnecessary procedures” than doctor pay. We will try No. 7 eventually. I don’t think No. 5 is very likely.

8) For what it’s worth, I am sorry about all this. I’m a journalist. Things used to be better for us, too.

9) It won’t be all bad. Patient outcomes will be better than they are now. Mistakes will be rarer. We’ll have a much clearer idea of what works and what doesn’t. Some form of serious medical-malpractice reform will become law. There will be less paperwork.

10) All this is to say, the endgame for the health-care system is that it spends a lot less than we currently project and works a lot better than it currently does. That’ll be tough for the people caught up in the “spends less.” It’ll be great for the people who are part of the “works better.”

By Ezra Klein  | March 11, 2011; 5:47 PM ET
Categories:  Health  
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Comments

here's a way to frame it: what would have to happen in the world of medicine and health care for Ezra Klein to stop writing about it.

Posted by: bdballard | March 11, 2011 6:04 PM | Report abuse

Change is scary. That being said, I really do think that most doctors realize that they are probably being underpaid for the work they do and will probably be willing to be more underpaid simply because of their passion for patient care.

Less paperwork and less defensive medicine will make the profession more attractive and that may cover the pay difference. So much of medicine is just paperwork and doing things that are known to be unnecessary, but necessary as a precaution against lawsuits.

Perhaps something on how our political system is equipped to handle these sorts of problems. One thing about doctors, they are very informed and knowledgeable about medicine, but once you get outside that arena, I wouldn't say that their knowledge is simply average, but there is a tremendous dropoff. This is more true for students who are very sheltered from the politics and policy of medicine.

Posted by: DDAWD | March 11, 2011 6:10 PM | Report abuse

IBM's Watson is a joke. It doesnt understand that if a patient complains of "stomach pains" it sometimes means that the person is really having tenesmus. A computer can give you a laundry list differential diagnosis and suggested workup for "stomach pains" but it cant make the needed human-like interpretation of what "stomach pains" really means to that particular patient.

BTW, the differential diagnosis for tenesmus is completely different than for abdominal pain.

Where Watson could help is if a doctor enters a question such as "please find all studies comparing albuterol, racemic epinephrine, and hypertonic saline for RSV bronchiolitis."

But a computer cant replace a physician.

Posted by: platon201 | March 11, 2011 6:14 PM | Report abuse

"One thing about doctors, they are very informed and knowledgeable about medicine, but once you get outside that arena, I wouldn't say that their knowledge is simply average, but there is a tremendous dropoff. This is more true for students who are very sheltered from the politics and policy of medicine."


Thats funny, I could say the same thing about lawyers, or journalists, or CEOs, or accountants, or any other group of people.

Posted by: platon201 | March 11, 2011 6:17 PM | Report abuse

"it cant make the needed human-like interpretation of what "stomach pains" really means to that particular patient."

presumably Watson would be able to ask questions about the nature of the pain which is pretty much what the physician would do.

"Where Watson could help is if a doctor enters a question such as "please find all studies comparing albuterol, racemic epinephrine, and hypertonic saline for RSV bronchiolitis." "

You don't need Watson for this. We already have pubmed.

Posted by: DDAWD | March 11, 2011 6:20 PM | Report abuse

"Thats funny, I could say the same thing about lawyers, or journalists, or CEOs, or accountants, or any other group of people.

Posted by: platon201"

My comment wasn't intended as a slam. I can't speak for these other groups of people since I spend very little time around them.

Posted by: DDAWD | March 11, 2011 6:22 PM | Report abuse

Never start singing a song or giving any speech with a disclaimer.

Instead believe you belong there and act like it.

Posted by: lauren2010 | March 11, 2011 6:24 PM | Report abuse

"5) In the future, either doctors will make less money than they are expecting to make now or there will be fewer of them than we project there will be now (perhaps because there will be more nurse practitioners and MinuteClinics). Politicians don’t like to say this clearly, but it’s true. It has to be true. If it isn’t true, America becomes functionally insolvent and ends up a “Mad Max”-esque dystopia . . . where doctors either make less money than they are expecting to make now or there are fewer of them than we project there to be now."

___________________________________________
MinuteClinics? Really? Are minuteclinics going to order an HbA1c test for diabetes and FOLLOW UP ON IT? Are MinuteClinics going to start statin drugs and check the required liver function tests before starting such agents, as is the required standard of medical practice? Are MinuteClinics going to help manage the average 75 year old patient with 12 different medications?

MinuteClinics are good for about 10 things and thats it: 1) strep throat; 2) skin infections; 3) UTI; 4) skin rashes; 5) URI; 6) ear infections; 7) flu shots; 8) headaches; 9) cough; 10) runny nose

For EVERYTHING ELSE, they are going to send you somewhere else. I cant believe you suggested that MinuteClinics can replace PCPs. Do you really believe that those 10 problems I listed account for a sizeable percentage of what PCPs see in the clinic? You're an idiot journalist pretending that he knows something about healthcare.


Posted by: platon201 | March 11, 2011 6:26 PM | Report abuse

And Watson need not replace a physician entirely. Think of the job of a physician as multiple jobs. Collecting histories, performing physicals, ordering and interpreting tests, making diagnoses, offering treatments, monitoring progress. Not to mention the softer stuff like comforting patients, discussing end of life care, etc.

Watson could presumably do at least two of these things, which are things the physician won't have to do or at least spend less time doing and spend more time doing the other things.

Posted by: DDAWD | March 11, 2011 6:31 PM | Report abuse

Tell them to give their best to get people to age 70-75 in good health and then kill them off as rapidly as you can after that, because those over the age of 75 are a tremendous burden on the economy as Japan has found out.

Oh I'm sorry, did I say that out loud?

Posted by: johnmarshall5446 | March 11, 2011 6:31 PM | Report abuse

Lets talk about nurse practitioners for a moment as well.

The state of New Mexico has a law that says NPs can practice totally independent of MDs. Zero oversight, zero chart review, zero billing, zero co-signatures on scripts, zero collaboration.

Now, guess how many NPs in New Mexico have made the jump to 100% independent practice?

Answer: ZERO.

This is in a state with HUGE swaths of territory with absolutely zero doctors, and yet STILL NPs arent exactly running to the area to set up shop.

You see, it turns out that NPs like to live in the same areas that doctors do, and in that situation where NPs and MDs live together, its nearly a certainty that the NPs will choose to work under the MDs "authority" rather than sign up for independent practice.

People who actually practice medicine know this and journalists and other so-called "healthcare policy experts" who think it sounds like a good policy decision dont understand why it doesnt work out like they think it will.

NPs replacing PCP MDs is a pipe dream.

Posted by: platon201 | March 11, 2011 6:34 PM | Report abuse

"And Watson need not replace a physician entirely. Think of the job of a physician as multiple jobs. Collecting histories, performing physicals, ordering and interpreting tests, making diagnoses, offering treatments, monitoring progress. Not to mention the softer stuff like comforting patients, discussing end of life care, etc.

Watson could presumably do at least two of these things, which are things the physician won't have to do or at least spend less time doing and spend more time doing the other things."

----------------------------------------

I agree. But thats a separate issue. I agree that computers like Watson can help doctors make better decisions. But thats not what Ezra was talking about. His clear implication that Watson would create a need for fewer doctors as it could effectively replace them. That, as I pointed out, is absurd.

Watson will make healthcare MORE expensive, not less as Ezra was claiming. Now it might be worth it in order to improve healthcare quality, but make no mistake Watson, robots, and other supercomputers wont lower healthcare costs.

Posted by: platon201 | March 11, 2011 6:39 PM | Report abuse

"Watson will make healthcare MORE expensive, not less as Ezra was claiming. Now it might be worth it in order to improve healthcare quality, but make no mistake Watson, robots, and other supercomputers wont lower healthcare costs."

Why? If computers are doing some of the tasks of doctors, it will be doing them at a cheaper rate, no?

Posted by: DDAWD | March 11, 2011 6:44 PM | Report abuse

The theme of Ezra's post is that doctors are the primary reason that healthcare is very expensive.

He's right, but not for the reasons he thinks.

Doctors are the primary drivers of healthcare costs because of the workups they order, not because their incomes are outrageous.

Its already well established that doctors incomes (gross) account for about 20% of total healthcare costs in the United States. Doctors net incomes, accounting overhead paid to nurses, utilities, malpractice, etc is only around 12%.

That means you could cut doctors net incomes by 50% and total healthcare costs would only go down by 6%. Not exactly the huge savings Ezra thinks it would be.

Doctors drive healthcare costs, but doctors incomes are NOT the primary driver of costs. There's a big difference there which means Ezra's proposals that we just slash doctor income across the board simply wont do jack to lower costs.

At the end of the day, Ezra's "we're sorry but you are making too much money and we need to cut your incomes for the good of the public" speech actually wont do anything like he says it will. A little bit of knowledge is a dangerous thing. Ezra would make a fine government bureaucrat.

Posted by: platon201 | March 11, 2011 6:48 PM | Report abuse

Why? If computers are doing some of the tasks of doctors, it will be doing them at a cheaper rate, no?

-------------------------------------------

For the same reason that DaVinci robotic-assisted prostatectomies are actually MORE expensive than human-only surgeries despite the fact that the computer effectively replaces several human tasks in the process.

Posted by: platon201 | March 11, 2011 6:51 PM | Report abuse

As a medical student, I think if I heard a talk like this, I would want to know what solutions might exist for minimizing the problem of student debt in such a future. This would not really be a problem for most specialists even if their pay were reduced dramatically, but if I have to go to an out-of-state institution where tuition is doubled, and if I want to go into family medicine or pediatrics, where the pay is a third of what many specialists make, the prospect of having a quarter of a million dollars of debt after med school is moderately frightening in a world where I would make less than a pediatrician does now. Perhaps you could bring up ideas like streamlining the medical education process. Some schools already take students after only two years of undergrad, and some healthcare policy researchers have floated the idea of a 3-year medical school curriculum for primary care physicians. Combining the approaches would leave only 5 years of education to pay for rather than 8, and at little cost in terms of practically useful coursework. Penn State even does a 1+4 year program. Examples below.

http://www.neoucom.edu/audience/applicants/succeed/admi/admiinfocurrentHS

http://www.science.psu.edu/premed/premedmed/accelerated-premed-medical

http://journals.lww.com/academicmedicine/fulltext/2007/09000/a_three_year_accelerated_medical_school_curriculum.16.aspx

Posted by: sgwin1 | March 11, 2011 7:01 PM | Report abuse

As a medical student, I think if I heard a talk like this, I would want to know what solutions might exist for minimizing the problem of student debt in such a future. This would not really be a problem for most specialists even if their pay were reduced dramatically, but if I have to go to an out-of-state institution where tuition is doubled, and if I want to go into family medicine or pediatrics, where the pay is a third of what many specialists make, the prospect of having a quarter of a million dollars of debt after med school is moderately frightening in a world where I would make less than a pediatrician does now. Perhaps you could bring up ideas like streamlining the medical education process. Some schools already take students after only two years of undergrad, and some healthcare policy researchers have floated the idea of a 3-year medical school curriculum for primary care physicians. Combining the approaches would leave only 5 years of education to pay for rather than 8, and at little cost in terms of practically useful coursework. Penn State even does a 1+4 year program. Examples below.

http://www.neoucom.edu/audience/applicants/succeed/admi/admiinfocurrentHS

http://www.science.psu.edu/premed/premedmed/accelerated-premed-medical

http://journals.lww.com/academicmedicine/fulltext/2007/09000/a_three_year_accelerated_medical_school_curriculum.16.aspx

-------------------------------------------

Ezra isnt interested in that. He's far too busy waving his finger in these med students faces with his righteous "I know whats wrong with healthcare and you DOCTORS making too much money is THE problem" to address anything else.

At the end of the day though, AMSA deserves this rebuke. I'm sure they were expecting Ezra to expound the virtues of socialized medicine (AMSA loves the UK system) and talk about how wonderful it would be for the UK system to be imported stateside.

Instead, they get a soapbox speech telling them that they are part of the "evil empire" and that they all need to be put back in their place. I'd love to be there and watch their smug faces retract in horror.

Posted by: platon201 | March 11, 2011 7:25 PM | Report abuse

Is this really a surprise? Like people in most professions that work for the public good, doctors are going to get dicked. Firefighters, cops, teachers etc. If you want money you should screw people over for a living, like Lloyd Blankfein. Doctors had it coming, and I say that as a med student. Like SGWIN, the focus now should be on reforming medical education, but it appears that for the first generation of physicians (especially those interested in PCP) like myself. Its bad news.

Posted by: simon341 | March 11, 2011 7:35 PM | Report abuse

Also, I appreciate Ezra's straight talk on this. I don't think he has the smug opinion that doctors are the main problem. I'm sure if he could make a speech to the American people, especially the right, he would remind them that at the end of the day they all die and sacrifices will have to be made in this most unusual sector of the economy.

Posted by: simon341 | March 11, 2011 7:37 PM | Report abuse

Wow, I don't get the 'doctors are overpaid' sense at all from this post.

What I get is that he's saying to the doctors that things will be different in the future, and that if you don't change, change will be imposed on you and you'll suffer if you're not prepared.

Doctors will have to communicate and collaborate more, use data-mining type resources to assist in decision making, and get used to not being paid by the procedure. That's not unlike what we middle management folks in corporate america have been doing for the last 20 years to be able to do more with less.

If he were talking to the insurers (as unlikely as that might be), he'd be telling them to get used to making less money too, and if they don't, change will be imposed on them as well. They'll have to realize that every dollar that doesn't go toward patient care needs to be evaluated constantly, or the Mad-Max scenario will occur as well. Again, not unlike the cost squeezing (with the help of technology) that just about everyone else has had to do too.

Can we please all be a tad less dramatic?

Posted by: LAGirl1 | March 11, 2011 7:40 PM | Report abuse

"Change is coming, change is scary, but scary or not, you will have to make a decision on how you respond to it. And saying that change won't happen or shouldn't happen or resisting change entirely, all are still decisions, but ones that reduce your influence on what the end-game looks like."

Posted by: ctown_woody | March 11, 2011 7:49 PM | Report abuse

I don't think doctor pay is the primary driver of our problems -- at all. But right now, pay is fee-for-service, usually. The quantity and cost of service is definitely a driver of costs. Cut down on fee-for-service, and over time, pay is going to be lower, too. American doctors will still make very good livings. Highest in the industrialized world, no doubt. But things will be different than they are now.

As for the question of competition, a lot of other industries, journalism included, have said that amateurs/computers/foreigners can't disrupt them. No one will want to read bloggers rather than journalists. No one will put Indians in charge of answer the telephone calls of English-speaking customers. No one will let machines take over your banking. And yet.

The point of this talk isn't that doctors are the problem. It's that medicine is going to change -- it has to. And it's going to change in ways that mean there's more spending control and more automation or less-skilled labor -- much like has happened to other industries. That doesn't have to be bad for individual doctors, just as it's not been bad for many individual journalists. But it does have aggregate effects that amount to "less." But perhaps I need to make that clearer.

Posted by: Ezra Klein | March 11, 2011 8:38 PM | Report abuse

Hey, does anyone know when Ezra speaks tomm.? The convention pdf has him speaking on Friday.

Posted by: CarlosXL | March 11, 2011 8:46 PM | Report abuse

'Ezra isnt interested in that. He's far too busy waving his finger in these med students faces with his righteous "I know whats wrong with healthcare and you DOCTORS making too much money is THE problem" to address anything else.'

As a future physician, I actually tend to agree with Ezra that most doctors do make too much and that wages will have to come down in order to address costs, particularly for specialists. I didn't mean to imply he was wrong about that. What I meant to get at was that if wages fell to, say, UK levels (which is fine), debt may end up being a prohibitive problem for some fields like peds, FM, psych, etc.; and there are some very workable solutions to this problem. That's really the only thing I'd add to Ezra's points.

Posted by: sgwin1 | March 11, 2011 8:47 PM | Report abuse

Or maybe it wouldn't be a problem. At the moment, there are far more qualified med school applicants than accepted students, so maybe people would still go into less lucrative fields even after a dramatic pay cut and no debt relief. I just know that as a student taking out massive loans, this is the part of the post that, rightly or wrongly, makes me a little uneasy about the future. And I expect the students tomorrow will have the same reaction if solutions aren't floated.

Posted by: sgwin1 | March 11, 2011 9:07 PM | Report abuse

Doctors don't make too much, old people refuse to die at a reasonable age and keep running for national office.

Where's Richard Lamm when you need him?

Posted by: johnmarshall5446 | March 11, 2011 9:11 PM | Report abuse

Hey Ezra, forgot to say best of luck

Posted by: johnmarshall5446 | March 11, 2011 9:29 PM | Report abuse

The whole Watson/Jeopardy event has me annoyed. Most of the conversation about Watson, both here and about the game in general, seems to take Watson, and its capabilities, as a fixed point in space. Watson isn't a solution for anything right now. It's a progress report on where computer/human interaction is and where it's going.

Watson isn't going to replace doctors, but some future version of Watson which is better able to understand and interact with humans will, or at least it will be able to assume a lot of the work currently done by people. It's just hubris to think that humans do some job better than any computer *ever* could. Any time someone says that I think, "Give it ten years."

Posted by: MosBen | March 11, 2011 10:26 PM | Report abuse

"In the future, either doctors will make less money than they are expecting to make now"

This is a conversation we really need to be having, rather than talking about teachers in Wisconsin, for whom the evidence suggests are compensated pretty fairly. American doctors are overpaid vs their international peers, and vs other professionals in the US such as law, science, or university-level education. Specialists in particular are wildly overpaid, probably by a third or more. And yes, this is factoring in the loans and insurance. It isn't hard to do the figures on an amortized loan over a career, and the pre-tax income one would need in order to pay it. It's not as much as you think. Nor can doctors claim that their wages are set by a "market" of any sort, as their production is gated by the AMA and the insurance industry is full of market failures.

Doctors in the US take home triple the earnings of the average American. Doctors in most other rich nations take home less than two and a half times the average....and in most cases, aren't lacking for doctors any more than we are.

Posted by: brickcha | March 11, 2011 11:09 PM | Report abuse

"At the moment, there are far more qualified med school applicants than accepted students, so maybe people would still go into less lucrative fields even after a dramatic pay cut and no debt relief."

Only about 40% of medical school applicants ever get into a medical school. Boosting that to 50% would increase the supply of doctors by 25%.

Posted by: brickcha | March 11, 2011 11:10 PM | Report abuse

"Patients are in awe of them [doctors], because they are sick and scared and desperate for the help of anyone who seems to know how to make them better.

4) For that reason, cost control theories that rely on the patient to become more sensitive to costs or the insurers to become more aggressive on costs will fail."

Some of us are skeptics. I have turned down the "opportunity" to have different major surgeries performed on me three times, as recommended by doctors in dramatic terms- all wrong. It almost seems as if doctors are unaware of the major infection risk, the risk due to medical errors, etc.- or maybe they just don't like me?

I think this is a real issue though- how do we start getting people to trust doctors less, without having to go through the mess I have?

One step is to radically reduce the number of medicines that require a doctor's prescription...

Posted by: staticvars | March 11, 2011 11:30 PM | Report abuse

http://www.kaiseredu.org/Issue-Modules/US-Health-Care-Costs/Background-Brief.aspx#How%20is%20the%20U.S.%20health%20care%20dollar%20spent?


You guys need to look at this chart very carefully. Total reimbursements to doctors accounts for only 21% of total healthcare spending.

Of that 21%, about 40% goes to overhead costs -- clinic nurses, medical malpractice, office space, billing services, allied medical services, etc.

So about 12% of that actually goes into doctors take home pay.

You could pay doctors ZERO take home pay and total healthcare costs would only go down by 12%.

Posted by: platon201 | March 11, 2011 11:33 PM | Report abuse

I think this is a real issue though- how do we start getting people to trust doctors less, without having to go through the mess I have?

One step is to radically reduce the number of medicines that require a doctor's prescription...

-------------------------------------------

Nobody is forcing you to go to a doctor. Please dont ever go to a doctor again for the rest of your life. Let us know how that works out for you.

As for prescription meds being available without a script, what exactly did you have in mind?

P.S. You can already get any drug you want via the internet with no doctors script required. Hell if you live in the southern US you can drive to Mexico and get whatever you want no questions asked. You can order any drug you want thru a Greek online pharmacy. Knock yourself out.

Posted by: platon201 | March 11, 2011 11:38 PM | Report abuse

Only about 40% of medical school applicants ever get into a medical school. Boosting that to 50% would increase the supply of doctors by 25%.

*******************************************

You are considering only MD programs, which only account for 60% of all medical schools in the United States. It also ignores foreign carribean MD programs, which place > 95% of their graduates into american residency positions.

There's been a flood of new medical schools over the last 5 years, nearly 40 new ones in all which are also greatly increasing the acceptance rate.

When you look at the AGGREGATE accept rate instead of just limiting it to US MD programs, the accept rate is closer to 60%.

At any rate, increasing the number of MDs will drive costs HIGHER, not lower. Thats why Boston, Miami, Los Angeles, and New York have the highest healthcare costs in the country DESPITE the fact that they also have the highest number of doctors per capita in the country.

The USA has too many doctors ordering tons of tests and doing tons of unnecessary procedures. We need less doctors, not more.


Posted by: platon201 | March 11, 2011 11:46 PM | Report abuse

"Nor can doctors claim that their wages are set by a "market" of any sort, as their production is gated by the AMA and the insurance industry is full of market failures."

****************************************************************************************

1. You're right, its not a free market, but not for the reasons you think. It also explains why increasing the number of MDs will cause costs to go HIGHER, not lower.

2. You dont understand where the bottleneck is in terms of producing doctors. Hint: its at the residency, not med school level. The number of doctors that the USA trains each year is about 40% higher than the number of US med school grads. The LCME, not the AMA, controls the US med school accreditation process. In the last 10 years the LCME has approved 22 new MD programs.

The AMA has absolutely nothing to do with controlling residency spots. That distinction belongs to Congress, who decided in 1997 that they didnt want to pay for more residency training slots. As a result, since 97 there has been an effective cap on residents. The AMA had no say on that.

Posted by: platon201 | March 11, 2011 11:55 PM | Report abuse

Ezra says:

"4) For that reason, cost control theories that rely on the patient to become more sensitive to costs or the insurers to become more aggressive on costs will fail."

You are so stubborn on this issue. Maybe the primary reason we so slavishly follow our doctors advice is because we know someone else will pay. And maybe the reason that doctors oversubscribe and perform coding the way they do is maximize their payment. I have an HSA and I am very sensitive to cost. I am constantly asking, "Is there a generic available, is a new lab panel really necessary?" etc. And my doctors know I have to pay for my care out of my own pocket and they are sensitive to what they order too. And every person I know that has an HSA has a similar story.

67% of Singapore's health care expenses are borne directly by patients. And they spend between 3 and 4% of GDP on healthcare. (And yes, I read your post on Singapore the other day. The mandates between Obamacare are not at all similar. One mandates insurance with all the problems of moral hazard, the distortion of the price system and adverse selection. The other mandates personal savings. I'll take the latter any day.)

Steve

Posted by: FatTriplet3 | March 12, 2011 12:04 AM | Report abuse

"You guys need to look at this chart very carefully. Total reimbursements to doctors accounts for only 21% of total healthcare spending"

What portion of the hospital and nursing home wedges go to doctor pay? Add that in, and you are probably closer to 20% of all medical spending going to doctors. That 20% is probably inflated by at least a third compared to what it should be in a competitive market, meaning we can save about five percent. That's a pretty large chunk of cash in a $2.5 trillion dollar industry.

Will cutting doctor and specialist pay down to earth solve our cost problems? Nope. But it is a large an necessary step in the right direction.

Posted by: brickcha | March 12, 2011 12:59 AM | Report abuse

What portion of the hospital and nursing home wedges go to doctor pay?

*************************************************************************************

None of it. Doctors who work only in hospitals or nursing homes bill insurance separately from the hospital/nursing home bill. Thats why the chart specifically separates that group out.

When a doctor rounds on his patients in the hospital setting, he has to fill out a billing card that gets submitted for reimbursement. That is kept absolutely separate from the hospital bill that Medicare pays to the hospital.

Posted by: platon201 | March 12, 2011 1:28 AM | Report abuse

1. If doctors were paid on outcomes now, they would be making minimum wage. Americans and sick and getting sicker. Just because someone with heart disease or Type II diabetes is breathing does not mean they are healthy or cured.
2. Doctors and the pharamceutical industry are the problem. They are not interested in having a healthy population; quite the opposite. They need sick people to make money and the standard american diet (SAD) plays right into their hands.
3. Change the SAD and people will be healthier and medical costs will drop significantly. It's really quite simple.
4. Getting people to change their standard diet is not so easy, but a good start would be: eliminating all agricultural subsidies and getting groups like AHA, ADA and USDA to understand that their advice and recommendations are dangerous and not based on any solid evidence.

Posted by: johnsonr1 | March 12, 2011 5:54 AM | Report abuse

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