(courtesy Wall Street Journal)
Here’s an inconvenient truth that some health reformers would rather not discuss:
Although the United States now has relatively fewer physicians per 1,000 population than the OECD median, its total national spending on physicians as a percentage of GDP is double the OECD median …
Physicians’ incomes are much higher in the United States than they are in other OECD countries. In 1996, the most recent year for which data are available for multiple countries, the average U.S. physician income was $199,000.27 The comparable OECD median physician income was $70,324.
Even more disturbing is the fact that primary care physicians who already earn far less than some of their peers are falling even further behind. Doctors can earn far more in the U.S. if they specialize in areas that lean heavily on costly interventions. That means that new doctors are deterting primary care, the specialty that’s arguably most critical to universal coverage plans.
The shortage of primary care doctors in Massachusetts, for example, is becoming a crisis just as the state attempts to expand coverage. Adding to the problem is the fact that doctors don’t only face disincentives to become primary care practitioners, but are also financially discouraged from serving the poor.
The Massachusetts program can’t fix those problems in a vacuum. As a result, the poor are still facing trouble getting primary care when they need it. And lower-income working people are now being “mandated” to pay for insurance coverage that they sometimes find they can’t even use.
“Doctors aren’t the problem,” Michael Moore said. Doctors may not be “the problem,” but there are certainly grave problems with their economic incentives – and with the choices they make as a result.
There are two serious issues that need to be faced in order to create universal coverage. One is the fact that doctors in certain specialties make a great deal of money by any standard, which places a cost strain on the system. The second is that fact that there will be incentives for entering these specialties – and for performing these costly interventions, independent of medical need – as long as our physician reimbursement system remains unchanged.
Moore and other reformers will have to overcome their reluctance to address the economic incentives of physicians, and other aspects of physician behavior, if we are to have an effective approach to creating universal coverage. This is just as true of single-payer as it is for any other kind of health reform.