Dialing, Dollars, and Doctors

June 10, 2009
Posted by Jay Livingston

The only health care costs I was thinking about when I started calling orthopedists today were my own. That’s why my first question was to make sure that the doctor participated in my insurance plan. I was calling only orthopedists listed listed on my plan’s website. But the woman who finally answered the phone of my first choice told me No.

The personal is the political, and I started thinking of all those warnings from conservatives that if the government gets into health care, we won’t be able to choose our own doctors, and we’ll be subject to incompetent government bureaucracy. It took only one phone call to discover that under what I have now, I can’t choose my own doctor, and that, at least when it comes to keeping their website information current, the insurance company bureaucracy isn’t exactly a paragon of competence.

A public option might be just as good. And who knows – with Obama in office, maybe the music you have to listen to while you’re waiting will be better.

I expected to be put on hold, and I expected the music. But I wasn’t prepared for the ads over the music – a woman’s reassuring voice telling me about all the wonderful kinds of surgery now available. It wasn’t as blatant as those ads on the subway decades ago for Dr. Tush* and his hemorrhoid surgery. The on-hold message didn’t exactly say, “What would it take for me to put you today into this quick and sporty little arthroscopic hand surgery?” There was also the difference that while the straphanger-friendly proctologist was going for volume, the orthopedists were aiming at a smaller customer base but pushing their more expensive products. Still, it was clear that all these practitioners were paying close attention to the bottom line.

Then I remembered that just this morning, Ezra Klein blogging at WaPo had said something along similar lines – less personal, more political and economic.

Reforms to . . . the way doctors are paid would actually do much to change the drivers of health-care spending. . . . Most doctors are paid on a fee-for-service model. Every time they do something to you, they get money for it. That's a subtle incentive toward expensive overtreatment. Conversely, if we paid doctors exactly the same amount overall, but made that money a yearly salary rather than a reward for volume of treatment, doctors would lose an important incentive to provide more health-care services than we actually need.

Ezra also recommends Atul Gawande’s recent New Yorker article, which ought to be required reading for anybody who has anything to do with healthcare.

* Amazingly, I could not find anything about Dr. Tush on the Internet. I’m pretty sure he wound up in prison, but I don’t know whether for medical or financial malfeasance