June 7, 2009
THE REASONS for the shortage of primary-care doctors have been clearly described: low pay, long hours, the crossword puzzle of insurance forms required to get paid – which leads to three administrative assistants for every doctor. But the issue is being framed using a classic tactic of the private insurance industry: in order to make ends meet, cut payments to higher-paid specialists and redistribute to primary-care doctors. This pitting of doctor against doctor is a classic tactic of the disastrous healthcare system in which we find ourselves.
When managed care came into Massachusetts decades ago, there was a massive advertising campaign to all doctors: “Unless you sign up with our company, you will wind up having no patients.” One would think that doctors would have gotten together and made it clear that they do the work. Without doctors, there is no healthcare. In a theater when someone collapses, has anyone ever heard the call go out: “Is there an insurance executive in the house?” If doctors had stuck together they could have prevented the abuses they’re now are battling.
The issue isn’t that primary-care doctors get paid less than cardiac surgeons, but that the system of healthcare rests on insurance companies and their CEOs making huge profits. No amount of cost-cutting can save enough money to support a for-profit system. The only solution is a universal, government-run healthcare system. Surveys suggest that a majority of Americans and doctors desire this. Any plan that puts private insurance in anything other than an optional, “concierge” system for the rich is just whistling past the graveyard of American healthcare.
The administrative cost for a private, for-profit health insurance system is approximately 33 percent ($300 billion annually); the administrative cost for the two government-run health systems, the Veterans Administration and Medicare, is about 3 percent. The level of satisfaction with these two nonprofit systems is high; that of for-profit is low.
Why in the world should healthcare be for profit?
Under a nonprofit system it would be easier for medical school graduates to go into primary care. Paperwork would go down drastically. No longer after a long day would a doctor have to spend an evening filling out dozens of different insurance forms, and then resubmit them a month later when they are denied or reduced. Doctors know that long hours come with the territory – most go into primary care because they like being with patients over the long haul of their lives. In a nonprofit system, they would no longer have the insurance industry rewarding them for limiting patient visit times to eight minutes average or stop themselves from ordering important referrals or tests.
Imagine yourself as a doctor: getting paid to practice bad medicine.
In order for a nonprofit system to work, two other needs must be met: tort reform, which will keep doctors from ordering needless tests to cover their butts for fear of litigation; and paying for medical education in return for national service, so that students don’t graduate with $200,000 in loans, and can’t afford to go into a lower-paying specialty.
How to pay for this? It is simply a matter of priorities. A whole year’s budget for the National Institutes of Health is a few days’ budget for the Department of Defense. In a humane society, providing good healthcare for all has to be a higher priority than spending half of our tax dollars for what, in my lifetime, seems like an endless progression of foreign wars.
How to get this done? The insurance industry is a powerful and ruthless lobby. Congress has an exquisite susceptibility to fear – in this case – “socialized medicine,” which we already have in the VA and Medicare. If all else fails, we may have to do what workers usually do to get bosses to give: organize doctors and other healthcare workers and plan a nationwide strike.
Stephen J. Bergman, under the pen name “Samuel Shem,” is a doctor and author of the novels “The House of God” and “The Spirit of the Place.”