Doctor fees

I’m actually sympathetic to doctors — yet in some respects, not. I get into these arguments with them all the time: “There is nothing but your own expectations making you send your kids to private schools, buy an expensive house or get a new car every two years,” I say. “You’re complaining about paying for private school, yet you live in one of the best school districts in the state. What’s up with that?”

One doctor I know (and appreciate, because he keeps his fees low enough that I can actually afford them) is always crying about malpractice insurance premiums and tort reform. “I have a friend in Texas who told me they capped jury awards there, and the malpractice suits went down,” he told me.

“I really wish I had your problems,” I said. “You’re saying that because you want a certain lifestyle, including a wife who stays home with your kids, that other people should give up their legal protections to subsidize that. When you make it impossible for victims to file lawsuits, it means your profession has made a conscious decision to subsidize the really bad doctors. That doesn’t seem quite moral to me.”

Malpractice premiums are driven by other factors anyway. When insurance companies were making a huge profit and premiums were low, doctors weren’t complaining then. Now, when the industry has taken huge losses in the market, they’re trying to make up the difference. The problem? Capitalism!

“Plus, you guys do a terrible job of policing your profession,” I said. “Remember, 95 percent of malpractice cases are generated by the same 5 percent of doctors.” (I used to be a medical fraud investigator; I saw the same familiar names, over and over.)

Still, when I read about this study, the researchers didn’t mention that when doctors sign insurance company contracts, they agree they won’t offer reduced rates to the uninsured. It would probably be a less controversial and more popular approach to make those contract conditions (i.e. insurance profitability subsidies) illegal, don’t you think?

WASHINGTON — Doctors are paid higher fees in the United States than in several other countries, and this is a major factor in the nation’s higher overall cost of health care, says a new study by two Columbia University professors, one of whom is now a top health official in the Obama administration.

“American primary care and orthopedic physicians are paid more for each service than are their counterparts in Australia, Canada, France, Germany and the United Kingdom,” said the study, by Sherry A. Glied, an assistant secretary of health and human services, and Miriam J. Laugesen, an assistant professor of health policy at Columbia.

The study, being published Thursday in the journal Health Affairs, found that the incomes of primary care doctors and orthopedic surgeons were substantially higher in the United States than in other countries. Moreover, it said, the difference results mainly from higher fees, not from higher costs of the doctors’ medical practice, a larger number or volume of services or higher medical school tuition.

Such higher fees are driving the higher spending on doctors’ services, the study concluded.

[…] The study examined fees paid by public programs and private insurers for basic office visits and for hip replacement surgery, and found that Americans were “very low users of office visits and relatively high users of hip replacement surgery.”

“Fees paid by public payers to orthopedic surgeons for hip replacements in the United States are considerably higher than comparable fees for hip replacements in other countries,” the authors found, “and fees paid by private insurers in the United States for this service are double the fees paid in the private sector elsewhere.”