RALEIGH – As Congress and the Obama administration continue to fashion a federal government takeover of the American medical system, it’s worth remembering that not all trends in health care are negative.
Indeed, some of the “problems” are really the inevitable result of prior “solutions.” For example, health care represents a much larger share of total spending than it did a generation ago in part because so many medical goods and services are truly worth more than they used to be – they alleviate more suffering, remedy more conditions, and save more lives. That’s not to say that money isn’t wasted on high-cost, low-return care. It’s simply to say that the challenge of affordability exists largely because health care has gotten more valuable over time.
Another category of good-news stories in health care involves innovations in the market for medical services.
I’ve written about some of these in the past: the minute-clinic model, the use of new pharmaceuticals to avoid higher-cost surgeries, and the overall trend towards consumer-driven health care in the form of health savings accounts, health reimbursement accounts, and wellness programs that give employees incentives to address chronic conditions that threaten both their own quality of life and the finances of their health plans.
The increasing use of lower-cost medical providers is still another promising trend. U.S. News & World Report recently wrote about some of the hottest employment opportunities in health care. They include dosimetrists (who help treat cancer), physician’s assistants, nurse practitioners, and nurse anesthetists.
I don’t mean to downplay the critical role of MDs in providing high-quality health care, but in the past they have been no less aggressive than other well-organized lobbies in seeking to protect their market position through controlling entry into the profession and excluding other professionals from competing for consumers.
One of the clearest differences between the American health care system and that of many other countries in the industrialized world – both those with government-run health insurance monopolies and those with a market-based system – is that doctors in the U.S. enjoy far larger average salaries.
Some activists and politicians believe that the proper response is for the government to regulate the compensation of physicians, ration patient access to physicians by rule rather than price, or otherwise pull the average salary of American docs ($146,000 for general practitioners and $271,000 for specialists) down to that of, say, France (about $55,000). But I don’t think the American people want some federal bureaucrat deciding how much doctors should be paid, or whether you can see your doctor in the first place. They’re right.
A better response is to give American patients more information and more choices. If they choose to take themselves or their children to lower-cost providers for initial care – say, at a walk-up retail clinic – they should be able to do that. Similarly, organizations such as hospitals, clinics, and medical practices should be free to substitute nurses and other providers for physicians when the expected benefits exceed the predicted costs.
In anesthetics, for example, the median salary of an MD specialist is about $250,000, vs. $125,000 for a nurse anesthetist. What is the likelihood of a complication requiring the intervention of a doctor? Is it high enough to justify artificial constraints on the use of nurse practitioners? The best available evidence appears to suggest that it does not. The fundamental point, however, is that government policymakers shouldn’t be making this decision. They’re not omniscient androids programmed with Asimov’s Three Laws of Robotics. They are politicians, and likely to be influenced as much by lobbying and political heft as they are by sound science and economics.
Policies that encourage more competition and more thoughtful use of the medical system, including information technologies and consumer savings accounts, represent a direction for health care reform that does not swap a flawed private system for a government-run system that would be far worse.
Hood is president of the John Locke Foundation