Health care costs are too high. Solving that problem is complex, but I do know one person who controls a lot of what's spent -- someone who might be able to alleviate some financial pain. I speak, of course, of your doctor.
A prescription for trouble
In the comments of an article I wrote yesterday, Fool reader Walker6464 pretty much nails the main problem: "Doctors get paid by the test, by the operation, by the procedure. Thus they have an incentive to do more tests and procedure, not provide better health care."
Can you imagine if the mechanics -- car "doctors" -- who work at the Ford (NYSE: F ) , Toyota (NYSE: TM ) , or Honda (NYSE: HMC ) dealership worked in the same fashion? You'd go in for a simple repair, and they'd want to run a few tests "just in case."
There are a couple of reasons why your mechanic isn't killing you financially, and why Washington isn't abuzz about car-care reform. (Do you support the "public carburetor option?") First, as Whole Foods Market (Nasdaq: WFMI ) CEO John Mackey explained, most people don't know the true cost of their health care. This leads to a simple, "Whatever you say, doc" when doctors order additional services. If they followed their mechanics' lead and handed out estimates, we might see patients responding differently to requests to perform additional services.
The other difference is who's footing the bill. Customers pay for their mechanic's services, but with health insurance, you're basically on the all-you-can-eat plan once you've paid your co-pay and deductible. If Medicare and health insurers like UnitedHealth Group (NYSE: UNH ) , WellPoint (NYSE: WLP ) , and Aetna (NYSE: AET ) paid doctors flat fees for treating medical problems, rather than paying them for a smorgasbord of procedures and actions, doctors' desire to cut costs would be aligned with their patients'.
Asking doctors to take on the financial risk for the inevitable patients who will be more difficult to treat won't be an easy sell, however, and it won't solve the other major problem that leads to high health care costs.
You're paying two insurance bills
Part of the charges from your doctor that you pay through your health insurance premiums go toward covering the doctor's malpractice insurance premiums. That high cost is linked to the chance of the doctor being sued, and the amount that the insurance company might be on the hook for.
If we lower the likelihood of winning a case against doctors, or the potential damages through tort reform, malpractice insurance costs will likely come down, reducing costs to the patient.
How much we could save, and whether the savings are worth the effort to restrict awards to patients who've been wronged by a doctor's mistake, is certainly up for debate. (Feel free to express yourself in the comment box at the bottom of the article.) However, it's clear that limiting lawsuits would reduce overall costs, if the savings from less expensive malpractice insurance and claims are passed onto consumers. Pair that with improving best practices, and the regulation of malpractice insurance, and some serious savings could result.
The government isn't helping
Perhaps the biggest health-care "waste" doesn't even come from the tests and services that benefit you. Instead, you're indirectly paying for costs incurred by Medicare and the uninsured.
Medicare pays doctors at a lower rate than private health insurers, and it continues to try and shrink that cost. Doctors were slated to take a 21% cut in Medicare reimbursement this fiscal year. But doctors have fixed costs no matter who is paying the bills, so doctors who take Medicare patients need to make up the difference in payments by charging health insurers at higher levels. The same holds true for the uninsured patients whom hospitals are required to treat. Those people may be visiting the hospital without paying a bill, but someone is covering the costs the hospital incurs.
The solution here is mandated health insurance. As our neighbors across the pond have learned, sharing the cost between the sick and the relatively healthy can average out the costs, although it's unlikely that it'll lower society's total health care bill all that much.
What do you think? Are doctors the problem, or is there a better way to solve the health-care crisis? Let us know in the comments section, below.
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