Thursday, February 21, 2008

James Schroeder on The Value of Health Care

The February 19, 2008 Grand Junction Free Press printed the following excellent LTE by Dr. James Schroeder:
The value of health care

James K. Schroeder, MD
Grand Junction, CO, Colorado

Value is a word we don't hear often enough in the health care debate. Proponents of universal health care rarely acknowledge the value of health care as a professional service. Stop to consider the time and effort that comprise a medical education. Years of study and long hours are devoted to attaining the basic physician's toolset. Many more years are needed to hone those skills and develop the judgment to use them wisely. This process builds substantial value. When proposing expansion of governmental control, advocates of universal health care blithely discount that value and belittle the quality you desire for yourself and your family. This country already faces massive shortages of primary care physicians in many locations.

Expansion of low-paying programs such as Medicaid and CHP+ will not improve that. In Colorado, expanding Medicaid with its low reimbursements has previously been shown to decrease the number of pediatricians accepting new Medicaid patients. Universal health care advocates are fond of saying that nurse practitioners and physician's assistants will fill that gap. In other words they are admitting from the outset that consumer's access to physicians will be effectively rationed. At the same time they try to equate the "value" of that care as if the consumer is not bright enough to recognize the difference. As it stands, prices for most medical services are determined by the federal government (most insurance companies tie their reimbursement rates to the Medicare-determined value scale). The talent, training and experience of the provider are not even considered.

A better solution would be to return to a competitive market environment. Let the system operate openly so that the value of the service (as provided by any given provider) and the perception of that value (in the view of any given consumer) will determine the monetary cost of that service. Don't expect college-age students to embark on a career in medicine or seasoned physicians to remain in the field if the value of their hard work is not acknowledged.