. . . The Real Reason Healthcare Costs So Much" (Harper-Collins) is a new book out by finanancial journalist, Maggie Mahar. Rob Ainbinder (The Blog and Nothing But The Blog/Randolph Is Talking) clued me into the book last week. I tracked a copy down over the weekend.
Quoting from the book's jacket: "In remarkably candid interviews, doctors, hospital administrators, patients, healthcare economists, corporate executives, and Wall Street analysts (they leave out lawyers) describe a war of all-against-all that can turn physicians, hospitals, insurers, drug-makers and device-makers into blood rivals. Rather than collaborating, doctors and hospitals compete . . . rather than thinking about long-term collective goals, the imperatives of an impatient marketplace force healthcare providers to focus on short-term fiscal imperatives . . . in theory, free market competition should tame healthcare inflation (but) when it comes to medicine, the traditional laws of supply and demand do not apply."
In other words, doctors don't get paid to keep you healthy and out of their office, they get paid when you're sick or in need of a procedure. "The perverse incentives of a fee-for-service system reward health care providers for doing more, not less."
Translation: surgeons rule.
And people wonder why doctors in the primary-care specialties (not to mention rural medicine) are struggling/floundering.? The corporate solution to everything . . . i.e. pumping up the patient volume" . . . doesn't fix the problems inherent to our system.
I have a habit of skipping to the last chapter in many books I read - to make sure I want to plow thorough the whole book to get there (it's an ADD thing). Mahar comes to the conclusion that doctors cannot remain "vendors" or "providers" or healthcare "retailers" . . . that "we must once again empower doctors to practice patient-centered medicine".
It was a read-it-and-weep moment.
I 've gone back to the beginning now and am still reading the book (inhaling it actually), but the conclusions Maggie Mahar ultimately reached only reinforce the principles I fought for when greedy, lying Randolph Hospital administrators worked their black magic on my life and career . . . when a so-called "non-profit" hospital opened up a can of whoop-ass on a Pediatrician in public service who put a patient first, and went way too far in order to preserve the "best interests" of their "controlled affiliate".
Every doctor on the planet (especially the young ones) should read this book.
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1 comments:
Hi Dr. Johnson,
I am a recent college grad, applying to medical school this year. I just bought book Mahar's book, hoping it would give me some insights into how the practice of medicine is evolving and what forces are affecting these changes.
While in college, I spent a lot of time shadowing a surgeon who had both a private practice and worked at the hospital. One thing I learned shadowing was that there is a business-side to medicine that impinges on how care is delivered. It's more than the added paperwork doctors have to go through. I also had the impression that doctors don't have as much autonomy in deciding the kind of treatment they think their patients should receive.
Despite this, I have to say, I'd like to think doctors still feel empowered by what they do. I still have this hopeful image of medicine being about self-sacrifice, of doctors working long hours to improve other people's lives because that is the job they signed up for. Otherwise, why didn't they go to law or business school after college?
In any case, I hope you plan to blog more of your thoughts on Mahar's book. If you would like to respond to my comment, feel free to e-mail me at darwinschild@gmail.com.
Thank you.
Karen
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