Be Careful What You Wish For – The Health Care Blog


I learn the Stat Information investigative piece “Well being care’s excessive rollers,” by Bob Herman and colleagues, with curiosity however not a lot shock.  I imply, is anybody stunned anymore that healthcare CEOs typically make quite a bit of cash, and didn’t let a disaster just like the pandemic dampen that?  As Kaiser Household Basis’s CEO Drew Altman advised them, “Well being care has develop into large enterprise. We’ve got lots of people making some huge cash in well being care, and we nonetheless have an affordability disaster in well being care.”

I periodically see Twitter threads lamenting how little of that healthcare spending truly goes to physicians, but individuals typically nonetheless blame them for that spending.  Physicians make a fairly respectable residing (a median of $322,000, in line with the 2022 Medscape Doctor Compensation report), though that compensation depends upon specialty, gender, race/ethnicity, and placement.  However possibly, simply possibly, the issue in healthcare is that we’re not paying physicians sufficient – not practically sufficient.  

I believe I understand how to repair healthcare.


There are about one million licensed physicians within the U.S., give or take.  I say, let’s pay every of them one million {dollars} a yr.  No, wait: they’ll must pay for his or her workers and different overhead out of that, so let’s say $1.5 million.  Heck, let’s simply spherical it as much as $2 million, and I may even see going to $2.5 million if actually pushed.  And let’s index that annual quantity to total CPI.  

The caveat, although, is that they’d must pay for all their sufferers’ care from that quantity.  Order a check, the doctor pays. Do a process, it comes out of the doctor’s pocket.  Prescribe medication or a medical machine, it’s the doctor’s accountability to pay.  Ship them to the hospital, identical factor.

It’s capitation writ massive. It’s world budgets on the doctor degree.  It’s the alternative of fee-for-service.  

Now, there’s a lot of particulars that might should be labored out. Many sufferers have a number of physicians, so deciding which doctor has to pay for which care wouldn’t be trivial. Additionally, a doctor might need an awfully costly affected person, so some type of stop-loss insurance coverage could be fascinating. 

And, after all, there’d should be a lot of negotiating.  I don’t image physicians tolerating the form of mark-ups on medication or hospital stays that insurers appear to tolerate, not when these “extra” costs come straight out of their backside line.  I can see teams of physicians negotiating collectively to drive higher offers, form of like Blue Protect was initially meant to do. 

I may also see billing codes getting a lot easier. All the present complexity helps maximize their income, however could be a value burden within the new atmosphere.  I might count on many different efforts at administrative simplification for that very same purpose.

Better of all for physicians and different critics of our present system, I’m undecided we’d want medical health insurance corporations or applications, apart from for the stop-loss safety I discussed above.  No extra prior authorizations, no extra inexplicable denials, nor extra contorted profit designs, no extra incomprehensible charge schedules. Should you’re going to must argue with somebody about care you suppose you want, would you somewhat that argument be together with your physician than with an insurance coverage firm consultant?


After all, we’d must someway guarantee physicians continued to see sufferers at wanted ranges; they will’t take the cash and determine they’re solely going to see a pair sufferers a day, a pair days every week.   We’d want some form of upkeep of effort or availability measures, in order that sufferers’ entry to care is a minimum of pretty much as good as now, if not higher. They’d must see sufferers no matter revenue, age, severity of situation, and so forth; no discrimination in opposition to sufferers.

However, some will argue, specialists have to make extra, in recognition of their abilities/coaching. Sure, we should always have that argument. We’ve been undervaluing and underpaying main care medical doctors for many years now, and this could be the time to make extra rational any variations that could be applicable. The present revenue variations aren’t defensible.

However, others will argue, how does this reward physicians over time? At present, the longer they observe, the extra sufferers they will see/the extra procedures they will do. That’s an asset in a FFS atmosphere, however on this atmosphere we would like physicians to learn to be extra even handed, less expensive, thus bettering their backside line whereas bettering affected person care.

There’s a hazard, after all, that physicians would possibly undertreat sufferers, would “ration” care, to the purpose that it has hostile impacts on their well being. That could be a concern, but when we’re not a minimum of as anxious concerning the present incentives to overtreat, then we’re not being practical. In each instances, we have to do a greater job of measures high quality and outcomes of care.

Do the mathematics: 2.5 million {dollars} for one million physicians is $2.5 trillion, versus our present $4 trillion spending. Throw in maybe one other half a trillion (!) for issues like public well being and oversight, and we’d nonetheless shave 25% of our present spending. 

If that’s not price excited about, I don’t know what could be.

Physicians decry the diminution of their position, their lack of standing, the period of time spent on paperwork and administrative duties. Truthful sufficient; let’s put them in cost and see how they do. It’s exhausting to see that they may do a lot worse.


Yeah, I do know it’s by no means going to occur. There are vastly vested pursuits in our present mess of a system, they usually’re not going to surrender their incomes with out a large combat. It’d be straightforward to say (though not right) that this could be a socialist construction, since presumably the federal authorities could be the one issuing these large paychecks. And possibly it provides an excessive amount of energy to too few individuals, even when these individuals are those we ostensibly belief most with our well being.

I put this on the market not as a result of I believe it may occur, and even ought to occur, however to make the purpose that if we don’t a minimum of think about “outrageous” concepts like this, we’re probably not pondering exhausting sufficient about healthcare reform.

Kim is a former emarketing exec at a serious Blues plan, editor of the late & lamented, and now common THCB contributor.

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