Webloggin » Socialism by the Hour

Playing Doctor It was interesting to see the New York Times run an editorial that called for a change in the way ~~patients~~ insurers pay for health care without explicitly advocating universal health care. Especially considering that the solution in the editorial would ultimately result in higher health care costs for everyone.

But then I decided to do a bit of research on the author and everything made sense.

The editorial, Care by the Hour, was written by medical doctor-novelist Robin Cook who just released a novel called “Crisis“. It was through a concept in that book and its connection to the phrase “concierge-style practices” that the pieces of the New York Times puzzle came together.

What are “concierge-style practices”? I thought you’d never ask.

You need go no further than the first sentence of the Amazon.com synopsis of Cook’s book to find out.

Bestseller Cook’s latest medical thriller focuses on a timely topic—the new and controversial “concierge” medicine that caters to the affluent willing and able to pay for special attention.

Ah, now it is all clear; this is all about limiting choice! We are talking about a certain rich-man poor-man tug-of-war that is central to liberal politics. Thus we now have some insight into the New York Times love tap.

But Cook’s editorial is more misleading than simply hiding behind simple catch phrases. It paints a picture of a failing primary health care system where doctors are swamped with too many patients, pay is low and the patient suffers from a glut of alternatives. The implication is that rich people are hoarding all the good doctors to themselves and the old style general practitioner is leaving the poor in the dust for more fruitful endeavors.

Cook’s solution on the onset would not relieve the problem unless you did one thing that is unmentioned in the article; limit choice. Canada did such a thing when they made private insurance illegal as an alternative to government provided insurance (provincial plans). The socialists in the Canadian government basically cut out private insurers who pay better than the government provided health care plans. You can still pay out of pocket but there is a catch. You can only pay out of pocket if you go to a doctor that has opted out of the provincial public plans. The net result was a thinning out of doctors who provided such care since they were not allowed to service the majority of Canadian patients who were insured by the government. No patients, no pay.

This is a neat little trick that allows the socialists to say that they didn’t make paying for medicine out of your own pocket illegal. Well yes, that is true. Instead they attacked the source in an effort to eliminate “concierge-style” doctor shopping. They simply made it impossible to find such doctors.

Cook’s deception by omission doesn’t end there. Go back to the first paragraph as a reminder of what sets the stage. [emphasis mine]

A PRIMARY care doctor I’ve known since we were residents 30 years ago recently described for me his typical day as foisted on him by current economic realities. He rises at 4 a.m. to make a dent in his avalanche of paperwork before dashing off to make rounds at the hospital and arrive at his office before 8. For the next 10 to 11 hours, he races through a series of patients so long, he cannot talk to any one of them as much as he believes he should, and he constantly worries he’ll miss something. Worst of all, he admitted, he no longer enjoys practicing medicine.

This is pretty bleak picture. One that I experienced first hand before I understood what was going on.

Cook continues to explain how the system got this way by describing that doctors are paid a flat rate per patient regardless of the diagnosis.

Each patient visit is generally reimbursed at a flat rate of slightly more than $50. The payment is the same whether the patient is a healthy, young person with a runny nose or an elderly person whose multiple chronic illnesses require many tests, referrals to specialists and detailed explanations to both the patient and his or her family.

So this is the crux of the low pay problem according to Cook. But what he doesn’t explain is that he is only describing one of 4 primary types of managed care plans. In insurance terms he is describing a fee based system called capitation. It is a managed care model (HMO, PPO) where doctors and doctor groups agree to see patients on a capitated, or per head, basis. This creates an incentive to stick in as many patients as possible to maximize the incoming money. Often times the health care providers agree to see a set number of patients per some given time period in a use it or lose it type of arrangement. These agreements lead to the type of situation described above where doctors basically have too many patients to handle in any given day.

But like I said, this is only one model of managed health care. Others involve discounted fee-for-service or staff models where doctors are paid a salary. You also have a mix of group models and individual models each of which may have different fee structures.

Unfortunately that is only part of the story. The problem with Primary Health care is not so linear. Doctors are leaving the field for many reasons and not all are related to the flat fee structure described above.

The Primary Care model leaves much to be desired. Patients have become more involved with the decision making and they have left primary care facilities in lieu of specialists who are more tailored to handle their particular situation such as asthma or arthritis. Why should one go to a primary care physician to treat a chronic condition that is better handled by a specialist?

Specialists also tend to be paid more. It makes sense that doctors are moving away from becoming general practitioners when you consider that patients are better served by a seeing a specialist and the specialist receives better pay .

Competition, another thing hated by liberal socialists, has lead to specialty hospitals and facilities that provide benefits not afforded in primary care practices. These facilities have many benefits that go beyond the basic primary care physician referral model. Often times the referral can be handled at one location.

Again, it comes down to choice and choice is not something that everyone has; especially people who are in systems provided by the government. This is the real rub.

Government plans tend to pay less than private insurance plans. Health care providers make up the slack by increasing fees for specialty services and taking more patients to make up for the shortfall in income. This is especially true in poorer communities whose patients are primarily insured by the government.

Thus what is really being painted as something that can be fixed by the government is actually a product of the government to begin with. Aren’t government provided solutions great?

There are many other points to rebut in Cook’s editorial that would require a much lengthier article. The bottom line is that Cook is describing a system that is a product of the managed health care system that was created by the government. It is a highly regulated system that has some serious flaws. Cook would like to throw that out and start over. Sound familiar?

It should surprise nobody that the New York Times printed this article before the 2006 elections. Victims are the bread line in the liberal play for power. If these socialists get their grubby little hands on healthcare we will all suffer the fate of mediocre service. Everything comes down to limiting choice in an effort to even the playing field between those who have and those who don’t. That is something that should motivate every conservative to show up at the polls and vote to defeat these people before it is too late.