Reason Writers Around Town: Shikha Dalmia on the Real "Evil-Mongers" in the Health Care Debate

Shikha Dalmia | August 26, 2009

In her latest Forbes column, Shikha Dalmia takes on one of the true villains in the health care debate: the American Medical Association. As Dalmia writes:

The entities that will be most injurious to the nation's health are not so much in the evil-mongers' group but the first group, including the American Medical Association—a doctors' cartel that has controlled the medical labor market in the U.S. like its personal fiefdom for a century. Instead of "palling around" with it, President Obama should do everything in his power to break its choke-hold and bring physician salaries—among the biggest drivers of health care costs--back down to Earth....

The association has managed so far to escape the wrath of MoveOn.org and other Democratic apparatchiks by muting its opposition to their beloved public option—the proposed government-run health care plan—and joining a coalition of industry groups pledging to cut $80 billion in health care costs over the next decade. The president has been touting these savings as if they have been signed, sealed and delivered to the bank. But anyone who buys—even for a nano-second—that anything good can come for taxpayers or patients from an alliance between Big Government and Big Medicine should see a doctor.

The fact of the matter is that even if the AMA delivered its share of these "savings," it wouldn't begin to make up for the costs it imposes on the country—both in lost dollars and poorer patient care....

Read the whole thing here.

Comments

|8.26.09 @ 4:20PM|#

woohoo im the first and only comment

|8.26.09 @ 7:23PM|#

I'm stunned to read such a poorly researched article from you. My dad is a surgeon and $400 grand might be the total his *practice* makes ... in a good year. But once he's paid insurance and corporate taxes and rent, his salary is just over $100 grand, which seems pretty reasonable.

I suspect those numbers on physicians are pure garbage and I would look much more carefully at that study. Doctors are leaving the field in droves because it doesn't pay well enough. Medicare fees have risen less than 20% (in unadjusted dollars) in the last thirty years, with private fees not coming up much more. Where are all these doctors earning four hundred grand? They certainly don't work in my building.

wayne|8.26.09 @ 8:15PM|#

his salary is just over $100 grand,...

A surgeon making $100K per year. I find that hard to believe.

|8.27.09 @ 12:08PM|#

Her article was a poorly researched mess. Most egregiously, she writes as if the AMA is something more than what it is: a lobbying group just like every other rent-seeking trade organization jostling for position at the federal teat. Think SEIU, the AFL-CIO, the dairy farmers, the sugar farmers...you get the idea. The respondent who remarked that residency slots, not med-school slots, are the chokepoint in the doctor-supply pipeline, has it correct. And they aren't even colluding very effectively to control numbers, given that most teaching institutions face severe service obligations that can only be met by increasing the numbers of low-paid trainees to do the work.

That said, I'd be happy to have a TRUE free market in healthcare providers. I'm an internist and anesthesiologist with ten years' post-college training under my belt, and almost two decades of practice experience. I have to believe that this skill-base has some value in a free marketplace for healthcare. Ultimately that, and not government fiat or cartel restriction, determines my salary.

So let's move to a REAL free market. No government licensing or regulation of ANY KIND. Let anyone who wants to hang out a shingle offer healthcare in return for full disclosure of his/her training, experience, and outcomes history. Let him or her purchase liability insurance coverage from anyone who'll provide it; and seek facility privileges from anyplace that will offer them. Physicians should not feel threatened by any of this. Why should I give two shits if someone wants to visit a chiropractor, aromatherapist, or cosmic-wave healer on his own dime?

But in return, any healthcare provider should be able to charge whatever the traffic will bear for his/her services, paid on mutually-agree terms between patient and provider. You want insurance reimbursement? That's between you and the Ginormous Health and Casualty Company. I expect to be paid for my services; just like your plumber, I don't work for free. No pay, no play.

Patients and providers would be able to choose, or reject, any relationship between themselves, and to define that relationship. A provider should be able to reject anyone who refuses to submit liability claims to arbitration or to whatever dispute-resolution method s/he chooses, and the courts should enforce this private contract. Providers will have to consider, in turn, whether such a contract provision makes them less competitive in the marketplace to ply their trade.

Similarly, I should be free to fire you from my practice if you become a pain in my ass by refusing to take my advice or abusing my office staff or generally ackkin' a fool. You may also leave at any time with my blessing. Since under this system medical records are the property of the patient, and made available to treating doctors on an ad-hoc basis, there are no records hassles to deal with. And if you want after-hours, night, or weekend care, expect to pay accordingly. (Ever try to get a plumber out on Christmas Eve? It's gonna cost you extra.)

With surprising speed, all of this will sort itself out as individuals make informed choices, and bear the costs of those choices. People will have to do some research ahead of time to see what healthcare resources are available in their town, at what price and quality level. (I'd say most patients do more research before buying a car than they do before having their hernia electively fixed.) You can expect that quite soon, hospitals and doctors will figure out how to offer prepaid packages of services so that someone with an exploding gallbladder, for instance, isn't haggling over price in the ER. Providers will compete on service and outcomes, and patients will get what they say they want.

Time will tell how well they are served by this new system. But at least no one can say s/he was compelled to do anything.

|8.27.09 @ 1:20PM|#

Jesus, I just looked at the NYT article she cites. It claims 400 grand as the top end for the most lucrative specialties. She twists that to be the low end for the poorest specialists. Who wrote this piece of garbage, Michael Moore?