Thursday, April 10, 2014

Does the Profit Motive Work in American Medicine?

Fat Cat Doctor
Furnish me the picture, and I will furnish you the Scandal

For Republicans, the private sector does everything better than the government. We ought to get the government out of everything, but especially we ought to throw the government out of medical care.

The Mitch McConnell's and Eric Cantor's and, Heaven Knows, the Koch brothers of the world all will tell you the greatest efficiency and the greatest good in any endeavor is gained by unleashing the powerful stallions of incentive and the drive for profit. That's what makes a system lean, mean and competitive.

But just show these same Republicans doctors who have been driven by that same incentive to bilk the government and Whoa!  Oh, the profit motive is just foul! When doctors seek to profit from the government, then the system is rigged and ought to be destroyed!

The New York Times, having set off the bombs in Market Square with a story about doctors raping the system to the tune of $21 million dollars a year is now feeling a little guilt stricken and today publishes an article in the business section which gives the response. Aude alterum partum. Hear the other side.  And, just as Mad Dog predicted, it turns out the amount paid for that $21 million dollars of eye care did not go to the bank accounts of the doctors, but to the bank accounts of the drug manufacturers. Well, mostly. The doctors kept 3% for profit, and many would argue that is too much. Why should doctors get any share of the drug profits? 

The Times, of course, had the perfect image of the perfect, porcine villain in the Florida ophthalmologist who led the money list.  Doesn't he just look like the prototypical fat cat rich doctor who has grown fat off the suffering of his fellow human beings?

Trouble is, likely he did nothing illegal. He just saw an opportunity, in this case afforded by Medicare, a government system, and he did just what the Koch brothers have always done: He moved in to take his profit. 

"Much of what Medicare pays them, they say, goes to the cost of the drugs they administer to patients in their offices and the bulk of that money ultimately goes to the drug companies." (NY Times--well, that's what they say!)

Defending himself, a Nebraska ophthalmologist who makes 3% profit on the injections (and that's just for the drug, not what he gets paid for the procedure) he says, "It's basically a problem created for us by the Medicare system."

See that? How neat is that trick? This doctor, a fat cat Republican no doubt,  profits from the system and then bites the hand that feeds him by denigrating Medicare as a flawed system! Now that's chutzpah! Well, it was right there for the taking! I had to take it! 

"If an internist admits someone to the hospital with pneumonia and they go to the I.C.U. and have a $300,000 bill,  that is not tagged to the physician,"  says the president of the American Society of Retina Specialists. "But when we treat someone for macular degeneration that gets attributed to the physician."

Yes, doctor. That is because the internist doesn't get a dime of that $300,000, but you, the retina specialist get at least 3% of the cost of the drug plus whatever you can collect for the injection. 

The eye doctors are right about one thing:  The system allowed them to profit. There is no way the government should pay the doctor for the drug and allow the doctor to profit for simply opening the bottle. The government should have paid the drug company, should have negotiated that $2000 a bottle price down to $200 (at which level the drug company would still accrue a profit of $100) and the government should pay the doctor for the service of doing the injection.  The government has allowed the doctor a "handling fee," and all the doctors did was to take advantage of that. In days of yore, the doctor was allowed an "interpretation" fee for the lab tests he ordered in his office and then sent out to a commercial lab, which did the work.  But that was ultimately disallowed because it was seen as providing a perverse incentive for doctors to order more tests to interpret. The interpretation of those labs was part of the service involved in the office visit and that was that.

Orthopedists may have to pay for the hardware they use to do a hip replacement. For that reason, orthopedists now do hip replacements in the hospital so the hospital pays for the hardware and the doctor collects his fee for the service of installing it. For other procedures, the orthopods take their patients to outpatient centers they own themselves and they profit from the fees for the nursing care, the inexpensive dressings and other equipment rather than allowing the hospitals to profit from all that.

All this is driven by our perverse "private only" and "incentive driven"  system of medicine, which we will never escape as long as Republicans control the Congress and the debate.

Other countries have long since addressed this profiteering. But we are the exceptional Americans. 
Aren't we lucky?

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