Dr. Tim Johnson, the former medical editor for ABC News, has written a terrific e-book in which he diagnoses what ails the U.S. health care system and offers a prescription for fixing it.
In “The Truth About Getting Sick in America” (Hyperion, 2010), Johnson asks what he calls the “big question”:
“Why does the United States spend more than twice as much per person on health care as all other industrialized countries when, paradoxically, it is still the only one that doesn’t provide basic health insurance for all its citizens?”
To figure out the answer, he says Americans need to examine what he refers to as the “four C’s;” namely, health care that’s convenient, compassionate, cutting edge and cheap or “even better, cost-free.”
Johnson says the lack of a primary care doctor who takes charge of a patient’s care is one factor that drives costs out of control. He writes:
“Today, health care is saturated with specialists who often don’t communicate with one another, order tests that have already been done, and often prescribe medicines without knowing what else the patient is taking. That’s one reason 20 percent of Medicare patients consume 70 percent of Medicare dollars; complicated patients amplify the inefficiencies and wastefulness that result when there’s no one in charge.”
With more than half of the health care dollar going to hospital care and physician and clinical services, Johnson says we have to change “the way we pay our doctors and hospitals. Ultimately, I believe we must pay all doctors by salary.”
He says physician salaries should be adjusted for patient load, hours worked, length of training and other factors. He argues that a system in which doctors are reimbursed for procedures and not for cognitive skills and patient outcomes will never constrain costs nor deliver the best of care.
Johnson cites 2009 figures from the Medical Group Management Association that show family practice physicians, pediatricians and psychiatrists all earning between $175,000 and $200,000 a year (certainly what most Americans would consider a comfortable income). In contrast, specialty physicians who derive the bulk of their income from procedures pull down much more with gastroenterologists, orthopedic surgeons, radiologists and cardiologists all earning between $400,000 and $500,000 a year; cardiovascular surgeons earning $519,00 a year and neurosurgeons topping the list at $609,000 a year.
Johnson writes:
“I am not saying that all doctors should be paid the same without regard to specialty. I believe that doctors who perform complicated, tension-filled procedures requiring longer training should be paid more than physicians who work under less stressful situations and/or have shorter training. But the differences should be less than they are today.”
Johnson argues that physicians should still be well paid and that it’s reasonable that neurosurgeons make more than a half-million dollars a year. “Put bluntly, $600,000 for a neurosurgeon with twelve years’ training after college looks paltry compared to the million-dollar bonuses for Wall Street traders with only four years of college.” But he says putting doctors on salaries would eliminate “the inherent conflict of interest in our fee-for-service system, which provides a direct financial incentive to do more.”
And he adds that the same financial dynamics that push doctors to do unnecessary tests and procedures apply to hospitals as well: “The more they do, the more they make!” The solution… figure out a way to pay hospitals for what works and what’s really necessary.
Johnson also offers critiques of the pharmaceutical industry, insurers, the malpractice system, and those in the media who hype unproven procedures and dangerous treatments.
After laying out the problems, Johnson addresses a fear widely exploited by conservatives and the Tea Party movement… that government regulation will stifle medical innovations and limit personal freedoms. Johnson is clear that “there is no way to get costs and quality under control without a strong role for the federal government.” He acknowledges his disappointment that a single payer system (a type of Medicare for all) wasn’t enacted in the health insurance reform law. And he lays out the reasons why he thinks the 2010 health insurance legislation will ultimately fail.
His predictions for the health care system of the future may surprise you. Johnson writes that before we can truly reform the U.S. health care system, we’ll need political leadership and personal sacrifice.
In an era where negative politics and personal enrichment are the order of the day, Johnson’s vision of the future speaks to an America that many of us hope for but few expect.
In 1970 he co-sponsored with Sen. George S. McGovern (D – S.D.) legislation in the U.S. Senate calling for the complete withdrawal of U.S. forces from Vietnam. That legislation ultimately failed, but Hatfield gained a reputation as an independent-thinking Republican who was not afraid to confront the war policies of President Richard Nixon.