Dr. Bruce Douglas’s perspective on taking money out of health care:
“Health care is a ‘service,’ provided by health care practitioners, that does not belong in the competitive, so-called free enterprise marketplace. Of course, doctors have to be paid, but the payment should not come directly from the patient. Reception areas in doctors’ offices should be places where patients register for care, provide their insurance information, fill out a history form, and wait to be seen by their doctor. Receptionists should enter the information in a computer and be fed all the information that has been stored, privately, about that patient, that the doctor needs in order to give the patient undivided, preventive-oriented attention. Money should not be mentioned, directly or indirectly, because health care, at any level, cannot be equated in dollars and cents.“
Is this a realistic view for an effective health care system? The patient doesn’t pay and the doctor doesn’t worry about cost? Actually, yes…if the insurer limits the phyisicans choices regarding what is insurable. In other words, this is managed care. The patient pays nothing or little, the physicians can prescribe whatever they want regardless of price, but the physician choice is limited to treatments that are approved by the managed care organization. However, Dr. Douglas does not support significant limitations on the physicians treatment choices. He describes the the growth of HMOs as “rationing raised its ugly head.”
If on the other hand, the doctor means that insurance should pay for whatever they want, doctors should prescribe whatever they want, and patients shouldn’t pay anything, well then this is a recipe for significant cost inflation. When insurance only covered severe hospital stay, patients would pay for most of medical care out of their own pocket. If this was the case, then the doctor’s recommendations would be accepted or rejected by the patient based on affordability and other factors.
Dr. Douglas’s solution is for a single payer system. However, even a Medicare-for-all system will face the same dilemma. Either, the single payer system will limit cost, but will have to ration care, or it will decide to cover all services but the cost of health care will increase.