It is widely thought that too much money is spent on American health care. An overabundance of specialists is thought to be a large part of the problem, since they do more, charge more, and generate more hospital and ancillary charges. With the collapse of the Clinton health care plan, health care reform is falling into the hands of middlemen such as insurance companies and HMO's. Patients are likely to encounter clerks or paramedicals rather than physicians. Physicians are forced to practice according to insurance companies' arbitrary guidelines rather than by their best medical judgment. The number of services approved is being reduced, as is reimbursement for those services. This double hit will reduce physician income to ridiculous levels, demeaning physicians as humans, driving many from the profession, and creating a technocratic slave class which would serve a public utility. Society would not respect what it expects as a "right" and physician morale would sink. Physicians would not be represented by a union, would not get merit raises for experience or superior performance, and would not get a pension. America will finally have fallen into socialism, with other industries inevitable targets. Paralyzing a very productive 13% of the American economy could cause chaos, not to mention health care of lesser quality. There is an easier way.
If there are too many specialists, let's get rid of, say, 200,000 of them. But let's do it in a way which is fair and respectful of those individuals and of American ideals: let's pay them for not working. Actually, let's pay them to drop out of medicine forever. Here's how it would work. Pay 200,000 specialists the average specialty income (federal income tax-free) for 5 years if they will cease practicing medicine forever. If the average specialist's income is $200,000 annually, then this would cost 40 billion dollars annually for 5 years. What would America get for this? If the typical overhead of a practice is 50%, these 200,000 specialists actually must generate 80 billion dollars in charges to supply their income, so this buyout would immediately save 40 billion dollars. But wait, there's more. Since specialists typically admit patients to hospitals, the associated hospital charges would also be saved. This might range from several tens of thousands of dollars to several millions of dollars per bought physician. If a typical specialist generated $400,000 in hospital charges annually, this would be another 80 billion dollars saved, for a total of 120 billion dollars annual real savings for 40 billion dollars spent over the first five years. This would increase to 160 billion dollars saved annually thereafter with no further expense. Signing bonuses could be offered to buy out specialists with particularly expensive practice patterns. This offer could be repeated at various intervals in the future to tune up the physician supply, but would never cost America more than the 200 billion dollars in the first 5 years, since future buyouts probably would not involve as many physicians. And the 4 dollar savings generated for each dollar spent just cannot be beat. Bought-out physicians could feel good about their circumstances since it would be a voluntary decision. They would have ample time and means to learn a new skill which would provide them with money and respect. Physicians near retirement would not be eligible for the full 5 years of subsidies, and future system savings would be inversely proportional to physician age at buyout. The plan supports true American ideals including sacrifice, freedom of choice, simplicity, and fair payment for services. The plan could be administered cheaply through existing federal agencies with no added bureaucracy. Economic models of payment for doing nothing already exist and function well in agriculture and professional sports, although payments in these 2 economic systems continue indefinitely.
This plan would benefit those remaining in the health care system, since there would be more money left over. All procedures could be paid for fairly, thus avoiding the "grey" market of discount medicine and eliminating the unfair double hit of reducing both volume of services and fees. The uninsured could be covered easily. Nurses' salaries would be protected. Medicare and Medicaid reimbursement could be increased. The health care industry would not be completely devastated from the bottom up, and fine-tuning of the remaining parts could continue, now with some breathing room. More cost-effective care could still be sought but with fair payment for those delivering it. Physician training programs can still put out more generalists, although some specialist programs might be closed or down-sized to avoid re-creating the specialist problem.
Everyone can agree that insurance company executives make too much money for the menial work they do, and everyone can agree that insurance company profits are already too large. Strict regulation of insurance companies would be required so that the enormous amount of extra money in the system would not end up as obscene profits in their pockets but would go toward paying those who actually do the work of healing.
But wait, there's still more. Medicare and Medicaid plans still might worry that the bulk of these incredible savings would go to the private sector. No need to worry, since there is plenty of money to be had by restructuring payment for these programs. All that is required is an expansion of the rules which are legislatively forced on physicians who supply Medicare or Medicaid services at discounts up to 60%. For example, if a grocery store receives a food stamp voucher for $1.00, the store gets a full $1.00 in reimbursement from a governmental agency. Subsidies also exist for those supplying low-income housing. We can all agree that there is too much waste in the food and housing sectors and everyone agrees that food and shelter are absolute American rights. This waste can be wrung out simply by passing laws that grocery stores must accept 50 cents for each $1.00 in food stamps, and subsidies for low income housing would also be reduced. There is no reason for greedy retailers or landlords to profit at all from supplying Medicare and Medicaid clients. This system has already been proven to work in the medical sector, although future minor tweaks will be required since it has been found that the demand for cheaper or free services is infinite.
Well, there you have it. Simple answers for simple problems. I'm sure the Republican-dominated Congress will be interested in these concepts and may try to steal them as their own. Just remember that you read it here first.