Requiem for Primary Care
So who really killed primary care? The idea that a centrally planned system with the right formulas and lots of data could replace the art of practicing medicine; that the human dynamics of market demand and the patient-physician relationship could be ignored. Politicians and mathematicians in ivory towers have placed primary care last in line for respect, resources and prestige—and we all paid an enormous price.
Full op-ed by Richard M. Hannan of BlueCross Blue Shield in The Wall Street Journal.
Hannan’s argument makes sense. Medicare underpays primary care physicians and private insurance follows Medicare’s lead. This resulted in fewer doctors willing to practice primary care. It probably also increased costs as the primary care physicians that remain perform more referals since they don’t have time to treat complex conditions.
I think this is a more serious problem than the health policy community acknowledges. Wealthier people are opting out by turning to concierge doctors.
Econ 101. You underpay, you get not only fewer doctors but the quality of care erodes.
My grandfather was a small-town GP for nearly 50 years who had an office in his house, got paid in fresh corn and home-made pies as often as cash. He loved what he did but finally hung up his shingle and quit answering the phone 24-7. He said he started out to practice medicine but, at the end, was spending more time on paperwork, insurance and outside regulations that left him no time to treat patients. Certainly, at what he charged, there was little monetary gain.
Family practice docs are becoming a dying breed.
Mr. Hannon rightly charges the federal government, aided and abetted by private health plans, with “killing” the family doctor by suffocating her under a Soviet-style bureaucracy that sets the fees of every medical service. Mr. Hanlon unfortunately neglected to indict the American Medical Association, the profession’s leading voice, as a co-conspirator.
The federal government largely outsources Medicare’s price-fixing to the AMA, for which it is well paid. The AMA reported revenues of $269 million in 2009, of which $210 million was from publishing, especially selling and licensing copyrighted intellectual property pertaining to the Current Procedural Terminology (CPT©), the codes to which Mr. Hannon refers.
The AMA enjoys a government-granted monopoly to supply the codes physicians need to submit claims for reimbursement. No wonder desperate physicians believe that government has failed to heed their voices.