The complexity of health care shows the problem of people becoming “experts” on topics in the blogosphere by reading and writing about a topic without actual first hand experience. Ezra Klein has written many excellent posts analyzing health care legislation but sometimes, such as yesterday, he posts total nonsense. (He does admit in another post that “I’m a policy guy, arguably to the point of myopia.”) He presents some misleading data in a chart which falsely suggests that health care costs in the United States are so difficult to control because physician office call charges are apparently around five times those in other countries.
The cost amounts he provides are simply not representative of actual real world numbers. The numbers he provides come from an association of health plans. Since when does he show such trust in data from health insurance companies? The numbers he presents are not representative of the real world range.
Even if he had more accurate numbers for office call charges, any analysis based purely upon charges would be misleading. Under our flawed system it is typical for charges to be well above what insurance companies actually pay. Charges are not an accurate reflection of actual payment and health care costs. Office call charges can also range tremendously based upon the time involved and complexity of the problem. Charges also vary tremendously depending upon whether you are referring to a GP or a subspecialist. Pulling out a single number for office call charges is meaningless.
Looking at charges also must take into account the differences in overhead expenses. It is not as if the doctor pockets these amounts as profit. Among other differences, overhead is much higher in the United States due to the need to hire additional office staff to handle a variety of insurance plans. In this case, any real differences in office call charges are a consequence of doctors also being a victim of our flawed system, not the cause.
Payment to physicians accounts for about twenty percent of health care costs, with around half of this going to overhead. Cutting payment to physicians will hardly bring health care costs in the United States in line with other countries. Blaming overall health care costs on physician office call charges is around as nonsensical as the conservatives who place most of the blame on malpractice expenses. Physician income has also been pretty flat in recent years while overall health care costs have been rising, further showing how it makes no sense to place the blame for problems in the United States on physician office calls.
Klein also believes that eliminating payment based upon fee for service is the solution. We already have tried capitation in the United States and it was a miserable failure. Other countries such as France provide high quality care at a lower cost while paying fee for service.
There are many problems with the health care system in the United States. Pointing to virtually meaningless numbers on office call charges does not provide the answer.
When you have filed bankruptcy due to high medical costs and have lived long enough to manage two chronic illnesses only then will you be an expert in health insurance policy.