Health Care - The Next "School Busing"

The headline on the front page of the newspaper said it all:

Want to keep your doctor?

Pony up $1,500

Scary... isn't it.  The first 3 illustrations in the article are about patients who love their doctors, but sadly can't afford to pay the $1500 annual fee the doctors want to charge.  But wait... is that the whole story...  not if you wade further into the article.  There isn't just a patient side to the story.   There is a doctor POV that is critical to understand.  And then there is the patient side that is never thought through...  look out !! ... 

Health care is the next "school busing."  

But first, you need some background.

The New Math For Doctors

Before you get upset with doctors, realize that there is new math for doctors.  With the rise in clout of insurance companies,  the Medicare system and malpractice attorneys, doctor profit and job satisfaction are at an all time low.

Doctor Job Satisfaction = (Profit per patient ×  Patients seen per hour × Hours Worked)  ÷  (Private life expectations × Law suits × Rate of cost increases )

How many doctors do you know?  I know several.  Almost all, except for high end specialists and plastic surgeons, are not having fun.  They are killing themselves working a ton of hours to make less money year after year.  And they do not see light at the end of the tunnel.  And here is the real tip that something is wrong... not one that I know would recommend their children go into medicine.... not one.  Doctors want to retire earlier... they are simply burning out.

How the "Fee" Works

So, what does the $1,500 you have to "pony up" get you?  If a doctor considers this new approach,  he is actually selling a different / better product to his patients.  Instead of having about 2,400 patients, the doctor cuts his load to 600.  By having 1/4 the number of patients, they can spend lots more time with each patient and have more time to spend with their own families.  The doctor can really know the patient and can be proactive.  Further, there is less doctor burnout.  These are often called "Concierge Practices."

An even higher touch approach reduces patient load to 50 families and charges $15,000 - $25,000.  These are dubbed "VIP or High-Touch Practices."

These options enable doctors to work more years, thereby increasing the supply of doctors.  They make general medicine more attractive.  These new ways of practicing medicine make the entire field more attractive!  The supply of good doctors increases.

Here Comes "School Busing"

Of course the articles about these practices decry this new trend. There is the warning of the "widening gap of care" creating a "new class system" in medicine.  Doesn't that make you feel horrible.  It may.. but it shouldn't.  Let's consider the alternatives to having free market options for doctors and patients.

1. We can mandate what doctor you get to "attend".
2. We can mandate each doctor's "schedule."
3. We can force patients to change doctors in order to adjust for doctor ability.  If one doctor is doing a much better job than another doctor, we can "bus" some of the good doctor's patients to the "bad" doctor.
4. We can mandate "quotas" for income, age, gender and racial makeup of patients for each doctor or group practice.
5. We can make medicine "unionized" with 3 pay tiers .... regardless of ability... regardless of results.... doctors can be locked into a pay tier.

In other words, we would have the equivalent of...

COURT ORDERED SCHOOL BUSING

 

... for patients and doctors. Will we attract the best and the brightest into medicine... NO!    Will we have fewer great doctors... YES!  Should the government control any one's free practice of their job... NO!  If we fall for the class warfare arguments, this means that:

 The primary goal of health care becomes 

a low standard deviation of care, 

even if the average level of care falls!   

Don't get sucked into the emotional arguments.

Let the free market work...

For Doctors 

For Patients

Byron Smith Blog