Free the Doctor

A doctor, writing in The New York Times, explains something many health policy wonks do not understand: The one person who typically makes all the important decisions about the use of resources and patient care in a hospital is the person who is trapped in a government-regulated, third-party payment system that perversely gives that person an economic self-interest in high-cost, low-quality care. The person about whom we speak is: THE DOCTOR.

The editorial’s timid idea: let doctors participate in “gainsharing” in federal pilot programs. Our bold idea: Free, liberate, release, unshackle, untie, untether, uncage, unpen, emancipate once and for all the only people who have ever — any time, any place, any where — discovered ways of delivering higher-quality, lower-cost care: DOCTORS!!!

Comments (6)

Trackback URL | Comments RSS Feed

  1. Larry C. says:

    I have always agree with you on this, John. But I rarely see any doctors agreeing. What’s their problem?

  2. Joe S. says:

    Good post.

  3. Joseph E. Gutierrez, MD says:


    You are absolutely correct !! Your comments are right on target !
    I commend you and congratulate for your comments …!

  4. Bob Geist says:

    John–the NYT op-ed is sohpistry, not freeing up doctors.

    To implement collusive provider arrangements, typically envisioned as a hospital-staff “system” as in the NYT op-ed, policy makers would have us subvert patient protection laws against provider fee splitting practices. They envision “coordinated” (or “comprehensive”) providers, paid capitation fees for servicing populations of HMO and government agency “insured lives”. The fixed budget capitation fee becomes an “incentive” to be financially “accountable”…or go broke. Gainsharing is the euphamism for providers splitting capitation fee profits by restricting the volume of care.

    Gainsharing was first made infamous in the late 1980s when a California hospital system shared profits with its staff for early discharge of Medicare patients for which hospitals were (and are still) paid by a fixed fee for a diagnosis. Discharge “quicker and sicker” summed up the public view. Thus,“gain sharing” was considered reprehensible and unprofessional fee splitting when providers colluded to profiteer by restricting care.

    Certain California congressmen made dire threats, but congress winked, because making gainsharing, illegal amongst providers, would endanger legalized gainsharing collusion between HMO corporations and providers. This is done by transferring underwriting risk to providers paid by capitation fees, precisely what the NYT op-ed writer outlined for the hospital-staff. The evidnce-free belief is that capitation pay (aka “payment reform”) will control “payer” costs (aka assurring corporate profits and government “savings”), since clinicians “spending” too much of their fixed capitation budget on patient care would be threatened with bankruptcy or at least get a bad “report card” ranking. Capitation pay does not free up doctors but makes them gatekeepers in financial conflict of interest with their patients.

    “Gainsharing” is sophistry of capitation fee splitting intended to “sell” the public and pundits on the “wisdom” of transferring third party underwriting risk to doctors and hopsitals. The sophistry that hides fixed capitation budgets and restricted volume of care profiteering is to call them pay for “quality”, “prevention”, “value”, “well care”, “outcomes”, and you name it. Another wink or blink at patient protection laws. Bob

  5. Ralph Kristeler says:

    —– Original Message —–
    Date Tue, 01 Dec 2009 13:10:03 +0000 (GMT)

    The Honorable Tom Price (D-GA)

    Dear Tom:

    Happy Thanksgiving to you Betty and Robert.

    Please forgive my informal salutation, however, we have been such good friends for such a long time that it just comes naturally.

    With regard to Health System Reform, thank you for supporting the view on the recent Coalition Conference Call that “fiscal responsibility” resonates with the public and we, the Profession, should ride the crest of that wave.

    Unfortunately, many of our colleagues see things from a strictly parochial point of view.

    Many years ago Jim Todd, EVP of our AMA, and one of my mentors, said, with regard to Medicare: “You can tell us what you will pay, don’t tell us what to charge.”

    Imagine if Medicare were converted from a “Physician Payment Plan” to a
    “Reasonable Patient Reimbursement formula.”

    It would dramatically change the landscape.

    It would empower patients to manage cost in place of Government control.

    It would put the patient in charge with the physician as a trusted advisor.

    It would mean that the National Budget would become “Budget Certain” i.e.

    predictable with reasonable certainty.

    It would eliminate Price Control on Physicians the only segment of our economy so egregiously afflicted.

    It would promote transparency

    It would make it possible for patients and physicians to contract freely without penalties.

    Most importantly: It is the fiscally responsible solution to the problem of
    Health System cost.

    Tom, thank you so much for listening and especially for all you do for the
    public – our patients – and for the Profession. A few more ethical, competent Legislators like yourself would not only reform the Health System, it would reform the country.

    All best wishes for continued success.

    The family joins me in sending warmest regards.


    Cc: The Coalition, Med Soc of NJ, et al.

  6. Don Prolo says:

    Dear John, Invariably your observations/comments are extraordinary, compelling and on target. All the physicians with whom I interrelate individually would endorse the concept of “freeing the doctor.” Unfortunately, many, but not all, national and state organized medicine groups manifest the “Stockholm Syndrome”, identifying as captives with the government or commercial insurers. Progressive detachment from time-honored professionalism and the sacrosanct patient/physician bond has followed mummification of the physician class as it leaves the academies and then confronts the force of payers. Some like the AMA obediently follow for mercenary reasons as chapters subsidized by the federal government. Please continue your prescient, forceful advocacy for patients and doctors. We all are profoundly indebted to you.