The Health Wonk Review features a post in which Matthew Holt, after seemingly interminable throat-clearing, stumbles across one of the most serious problems facing American health care:
We have a huge over-preponderance of specialists who both earn way more than primary care physicians, and use considerably more resources.
Unfortunately, Holt fails to comprehend the significance of his discovery. Like most “progressives,” he sees economics as a zero-sum game, and thus concludes that the way to build up the ranks of primary care is to prevent people from becoming specialists:
What’s the rational answer? Do what most other countries do and restrict the amount of specialty positions available. Instead insist that most physicians focus on primary care which is both cheaper to the system and more cost-effective.
The implementation of such an economically naïve policy would have virtually no effect on the shortage of PCPs. Its primary result would be the creation of an additional shortage—of specialists. Deprived of the specialist option, the best and brightest will not suddenly become willing to work for submarket wages.
We have more specialists than PCPs because the pay is better for the former than for the latter. Why is PCP reimbursement so anemic? Well, as Kevin Pho points out in a recent op-ed, it is the direct result of government meddling.
And, Holt’s fond illusions notwithstanding, in “most other countries” whose bureaucrats have attempted to “manage” physician supply, there are shortages of PCPs and specialists. In Canada, for example, such policies have backfired horribly.
One of these days, “progressives” will figure out that the halt cannot be cured by increasing the ranks of the lame. Unfortunately, they will probably do a lot of damage before they finally discover the free market.
Comments 5
“We have more specialists than PCPs because the pay is better for the former than for the latter. Why is PCP reimbursement so anemic? Well, as Kevin Pho points out in a recent op-ed, it is the direct result of government meddling.”
Well, the Medicare cuts are for all physicians; specialist or PCP. A 99213 from a PCP is the same as a 99213 from an Internist, and if the Doc’s are in the same geo zip the allowable will be the same. The reason a specialist makes more money are the extensive corresponding procedures / tests a specialists can perform.
I think what most people don’t realize is that most if not all commercial insurance physicians fee schedules are based on a percentage of Medicare’s physicians fee schedule. So if Medicare is making cuts, guess what? Everyone else is going to make the same cuts.
Posted 10 Aug 2007 at 12:15 pm ¶That you take Medicare’s Byzantine reimbursement system for granted is evidence in favor of my argument.
Uniform OV reimbursement is absurd. And that specialists need to order more tests (or whatever) to squeeze adequate reimbursement out of the system is even crazier.
All of this results from bureaucrats attempting to outsmart the market. In a free market environment, PCPs and specialists would charge what the market would bear.
This would result in supply/demand equilibrium for PCPs. Shortages would go away.
Posted 10 Aug 2007 at 12:54 pm ¶‘Unfortunately, they will probably do a lot of damage before they finally discover the free market.’
So this is the advice from someone aligned to the collapse in sub-prime lending, Enron and other criminal rip-offs, and protectionism dressed up in free market economics that continues to strip the developing world of resources to feed itself by selling American rice to Africa.
The more I learn about American healthcare as a UK based writer the more it’s transparently obvious that Americans are crying out for security, and not an expansion of free market choice dressed up in a myriad of confusing and competing insurance plans.
Your healthcare system is already 50% ’socialised’. There’s only one way to go that’s decent and proper, as every other developed nation knows.
Posted 11 Aug 2007 at 2:44 pm ¶Your healthcare system is already 50% ’socialised’.
Indeed. Most of the system’s problems can be traced back to that very reality. The free market will fix most of them.
Posted 11 Aug 2007 at 4:25 pm ¶You’re talking nonsense. There’s no such thing as a free market in healthcare, as in most other things. You’re arguing for less regulation, which is not the same thing. You fail to also address the gross problems that lack of regulation brings on. Do you want a healthcare Enron?
Posted 11 Aug 2007 at 4:41 pm ¶Post a Comment