The NYTimes published a woefully misguided piece on the “specialist stranglehold” on modern US medicine.
So, doctors are to blame for setting the prices for reimbursement by private health insurance companies? And they are also to blame for pursuing extra years of low-pay resident/fellowship training so that they can do advanced procedures and be paid decently for their work? And, they are also to blame for “defending their turf” within a specialty — that is, for specializing at all?
And, this article is even written by a doctor?! Why, yes, of course, it is!
I think medicine may be the world’s most self-hating profession. Trapped inside a system that takes advantage of their altruism, ridiculous work ethic, and decades of training, they can’t help but blame themselves even as the capitalists around them exploit them.
The author could benefit from reading David Foster Wallace’s commencement speech (“This Is Water”), as summarized here and as reprinted in full here.
The only correct statement in the NYTimes story was this: “But deregulation will not fix it. To the extent that we can call it a market at all, health care is not self-correcting. Instead, it is a colossal network of unaccountable profit centers.”
But the author then goes on to describe the profit centers as… other doctors! Specialists, only, of course.
The profit centers are not the doctors. Ask any hospital or health insurance company. For them, physician labor is a cost center. The biggest profit center of all is the one farthest from care: the health insurance company.
Follow the money. The reason specialists are paid well is because health insurance companies reimburse procedures, not primary care, at high dollar amounts. The author is right that primary care doctors should be paid more. But the author is wrong that specialists should be paid less. This isn’t a zero sum game. Doctors are the value in the system. The administrative overhead is the waste.
It’s the waste that’s eating the money, not the value. See also cost disease.