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Time takes the entire nation to the doctor

December 1, 2008

The December 1 issue of Time features an in-depth assessment of American’s health.  I was very excited to pick up this issue and see how exactly the mainstream media rates our health and what they consider to be the biggest challenges to a healthier America.

First and foremost, I have to commend Time for basically dedicating an entire issue to the state of American health.  The mainstream media always features “hot” health topics and major medical advances.  However, they rarely take a step back to look at the bigger picture and consider the whole of our health care system.  The scope of Time’s main article does a very good job of hitting the major topics.

Unfortunately, some glaring omissions are made in their assessment of American health and our health care system.

1) Reimbursement Structure

I can’t really fault Time too much for failing to discuss the exciting world of physician reimbursement in the American health care system.  It’s complicated and necessitates quite a bit of boring history to understand why it is the way it is.  Unfortunately, Time completely misses this topic when it discuss what it considers to be the biggest problem in the US health care system–lack of preventive medicine.

Perhaps the biggest reason preventive medicine is appallingly absent from most medical practices is because the payers (Medicare, Medicaid, and private insurers) don’t pay doctors adequately for providing such care.  Unfortunately, doctors don’t get paid to talk to patients, they get paid to do things to patients.  It is much more profitable for a doctor to DO something (like putting a stent in an artery) than TALK about something (like why diet and exercise are so important for preventing heart disease).  Our current payment system is based on procedures done, thus doctors want to do procedures in order to receive payment.  This means preventive medicine is largely left out because preventing disease usually doesn’t involve doing a procedure.

2) Medical Education

Several problems exist in our current system for educating future doctors.  The biggest, however, has to be how much debt medical students must take on just to complete their education.  The average medical student debt load at graduation is currently around $140,000.  Although the general public may not consider this a problem because of the high wages doctors generally command, it is an ever increasing problem because it is driving more and more into high paying specialities.

So what?  We have more specialists, why is that a problem?  Well, going back to the reimbursement problem, specialists largely perform procedures for specific conditions.  They also tend to overtreat patients with basic problems because they are used to seeing complex conditions during their training.  More specialists means fewer primary care physicians who are the primary providers of preventive medicine.  This means less preventive medicine, more procedures, and ultimately greater cost.

Another large problem with our medical education system is capacity.  We are currently facing a large doctor shortage.  Although medical schools are expanding capacity, they are not keeping up with demand, especially as our nation ages.  This means fewer doctors for an expanding patient base.  As Massachusetts has demonstrated, too few doctors means long waits to see a physician, leading to more complex disease states and higher cost of care when people do get in to see their physician.  This problem will be further exacerbated as health care reform plans provide insurance for more patients.

The Time article fails to even mention the critical role medical education plays in the health of our nation.

3) Cost

Although Time mentions cost in several places, it fails to critically evaluate why costs are so high.  As I’ve already pointed out, our reimbursement structure is one big reason why costs are so high.  Perhaps the second biggest reason costs are so high has to do with how health care consumers are insulated from the true costs of their care.  Most consumers of medical services in the United States have health insurace.  This means that instead of paying the $120 a typical doctor’s visit may cost, they pay a $10 copay and monthly health insurance premiums.  Since patients don’t pay those costs directly out of their pocket at the time of service, there is no incentive for judicious use of medical services.  If a patient tweaks their knee in the annual family Thanksgiving football showdown, why not go to the doctor and get a MRI?  A more direct payment system–such as those with high deductible insurance plans coupled with health savings accounts–may lead to lower utilization of medical services.  Unfortunately, this is a very complex problem due to what economists call the “asymmetry of information” inherent in health issues.  It’s difficult for an individual to know exactly when he or she should go to the doctor for a tweaked knee or stay home and ice it simply because individuals lack the expertise to make that judgment.  That’s exactly what they pay doctors for.

These three issues represent only the biggest issues missed by Time.  Our health care system is extremely complex and many other factors affect American’s health.  As I said before, I commend Time for drawing attention to the health care policy issues facing America.  I hope in the future, as health care reform takes center stage in our country, the mainstream media will take on more in-depth analysis of this issues and directly address the three I’ve mentioned here.

One Comment leave one →
  1. January 18, 2009 11:34 pm

    Primary care doctors DO a lot. They just don’t get paid for it under the current system. My PCP helps me manage a couple chronic conditions; provides common sense advice, and helps me understand my medical frustrations. She keeps me out of the ED and helps me avoid procedures (I willingly have my annual Pap and mammogram).

    Primary care providers need to be compensated fairly for what they do, and should not have to work ridiculous hours seeing ridiculous numbers of pts daily just to keep their heads above water financially.
    (Disclaimer: I have no bones to pick with specialists; I see a couple of “part doctors” myself.)

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