The Specialists’ Stranglehold on Medicine

Jamie Koufman
The New York Times - Opinion
Originally posted June 3, 2017

Here is an excerpt:

Neither the Affordable Care Act nor the Republicans’ American Health Care Act addresses the way specialists are corrupting our health care system. What we really need is what I’d call a Health Care Accountability Act.

This law would return primary care to the primary care physician. Every patient should have one trusted doctor who is responsible for his or her overall health. Resources must be allocated to expand those doctors’ education and training. And then we have to pay them more.

There are approximately 860,000 practicing physicians in the United States today, and too few — about a third — deliver primary care. In general, they make less than half as much money as specialists. I advocate a 10 percent to 20 percent reduction in specialist reimbursement, with that money being allocated to primary care doctors.

Those doctors should have to approve specialist referrals — they would be the general contractor in the building metaphor. There is strong evidence that long-term oversight by primary care doctors increases the quality of care and decreases costs.

The bill would mandate the disclosure of procedures’ costs up front. The way it usually works now is that right before a medical procedure, patients are asked to sign multiple documents, including a guarantee that they will pay whatever is not covered by insurance.  But they will have no way of knowing what the procedure actually costs. Their insurance may cover 90 percent, but are they liable for 10 percent of $10,000 or $100,000?

We also need more oversight of those costs. Instead of letting specialists’ lobbyists set costs, payment algorithms should be determined by doctors with no financial stake in the field, or even by non-physicians like economists. An Independent Payment Advisory Board was created by Obamacare; it should be expanded and adequately funded.

The article is here.