With all the news coming out of Washington about the future of health care, editorial pages and TV pundits alike seem more interested in playing a shell game by blaming and scapegoating rather than carefully reporting. A recent example was this newspaper’s editorial where it asked, then answered, its own question, “What about Docs?” (May 7) in an attempt to blame physicians for the high costs of medical care.
Contrary to misinformed arguments, doctors are not “the parties who set the price in the first place” of health care. No, that would be the federal government, which sets Medicare rates, insurance companies, which set what they decide to pay physicians, and (to a lesser extent) hospitals, which charge for everything else. The physician at your local hospital or private practice has little to no control over what a patient is ultimately charged for, say, setting a broken leg, treating a heart attack, receiving a CT Scan, or providing chemotherapy.
In fact, the basic premise of out-of-control medical costs is wrong because healthcare costs have been leveling off since the 2010 passage of the Affordable Care Act. Much of this improvement has come through the relentless efforts of physicians to cut costs.
Choosing Wisely, a national program to eliminate unnecessary medical testing, is but one national physician effort that has saved millions upon millions of dollars. Unfortunately, in the factually-challenged realm of political punditry, such hard-earned savings are conveniently ignored.
The cost of medical care is a complex problem with a myriad of components.
Many of these have nothing to do with actual patient care, but rather stem from exorbitant malpractice insurance fees resulting from the often lawsuit-happy world in which we live.
In addition, physician’s offices must now hire entire departments of staff just to appeal insurance companies’ denials of authorizations for patient care and prescriptions. (I know doctors who come home in order to have dinner with their families, tuck their kids in bed, then return to the office to complete mounds of paperwork.) And medication costs soar by hundreds of percents just because a drug company executive gets greedy. To make matters worse, Congress passed laws that prohibit the federal government from even negotiating lower prices on medications.
Contrary to the faulty implication of imaginary fat cat doctors, typical physicians in private practice or those employed by local hospitals make nowhere near the figures thrown about. In fact, physician salaries have been level for slightly more than 15 years. I googled “highest paid editors” and learned some make well over a million dollars a year. Would it be responsible for me to report all Times-Dispatch editors as similarly compensated? Hardly.
Informed readers should also know that over the years, Congress has failed to increase support for new physician education by blocking increased federal support of medical schools and residency programs. As a result, new doctors begin their careers facing crushing debt loads.
Consider this: The median four-year cost of attending medical school in the United States in 2016 topped $240,000 in public universities and $314,000 in private ones. Coupled with undergraduate loans, many medical students graduate are mired in debt ranging from a quarter to over half a million dollars.
But wait! Four years of medical school are just the beginning. A doctor must then complete three to seven more years of residency training, depending on their specialty. Your child’s neurosurgeon or pediatric interventional cardiologist trained even longer.
Richmond-area physicians have been working hard to practice smarter, and more economical, forms of medicine. They have formed Accountable Care Organizations (ACOs) that have streamlined care and made it possible for primary care physicians and specialists to work together across systems to improve care while lowering costs.
This, in turn, has saved the taxpayers millions of dollars under Medicare. To cite but one example, a local urology practice, Virginia Urology, changed its technique in lithotripsy (blasting kidney stones) and as a result has saved the federal government more than $10,000 a month since 2009.
Another deceptive tactic of the health care blame-game is to criticize physicians for not doing enough charity care. At the Richmond Academy of Medicine, our physicians have always been generous in providing free charity care, whether it’s by volunteering at the area’s high-quality free clinics or by providing free specialty services through its own free clinic for specialty care, Access Now, which was begun by RAM in 2008.
At last count, our 880 physician volunteers and other healthcare providers have provided more than $37 million in free care to more than 12,000 area residents since Access Now began. Our physicians and related professionals get no tax breaks from this work. They do it because they care about people, and helping them get well and stay healthy. The same should be said of our local hospitals, which give millions each year to care for patients of Access Now as well as others who lack insurance.
Reasonable people can disagree on the recent House bill to repeal large parts of the Affordable Care Act — in fact, national organizations representing insurance companies, hospitals, and physicians have done so. But it does the public a disservice to blame doctors by falsely implying they are somehow overpaid and driven by greed. Physicians are not the problem, and, indeed, they are active in being part of the solution.
There is one thing all the media hype accurately shows (at least if one reads between the lines): Healthcare has become a pawn in a lose-lose partisan game of politics where patients and their physicians are scapegoated for the government’s failure to put patients above profits. It’s a game where patients and providers fall victim to the power of wealthy politicians and mega- corporations with high-dollar lobbyists.
Yet at the end of the day, patients are still receiving quality care and physicians are still hard at work checking medical records, filling out government forms, and fighting with insurance companies on behalf of their patients.
Here’s the true answer to the editorial’s question, “What about Docs?” They’re treating you.