so are Jim Cooper and NPR's editors.
Today, NPR published a story called "Taking Doctors' Profits out of Medical Decisions.". "Moderate" insurance industry lackeys Sen. Olympia Snowe (R-ME) and Rep. Jim Cooper (D-TN) agreed that the problem with US medicine is that doctors are paid by the service provided, and that gives them an incentive to do unnecessary procedures.
Here are the money quotes. Cooper:
With the fee-for-service model for health care, Cooper says, doctors have little reason to discourage the demand for more and more health procedures.
"I liken fee-for-service medicine to the situation if we paid lawyers by the word, or by the paragraph," he says. "We would have the longest legal documents in the world, and essentially, that's what we do with our doctors, but most of us don't realize it."
Snowe, who is now, evidently, writing the final health care bill:
Republican Sen. Olympia Snowe of Maine agrees with Cooper. Snowe is one of three Republicans working with three Democrats on the Senate Finance Committee to forge a bipartisan health care bill. She wants legislation holding doctors and hospitals accountable for both the cost and the quality of their treatment.
"The fact is, right now, we encourage volume over value," Snowe says.
The story was reported by NPR's David Welna. Idiots. All three.
Here's the question genius Welna didn't ask, and so the bipartisan insurance industry employees didn't have to answer:
If fee-for-service payment to doctors is the root of all medical evil, how come France and Canada, whose costs are way below ours, whose outcomes are way better than ours and who cover everyone, reimburse doctors on a fee for service basis, and don't have the same mess we do?
It's the insurance industry, stupid. Our system isn't facing a cost explosion and coverage implosion because of fee-for-service reimbursement. It's because a multi-payer system run by for-profit corporations generates staggering amounts of waste in the form of unnecessary administration, overhead and profit. Our hospitals spend more than twice as much on administration as Candadian hospitals do because they have to chase for-profit insurers for payment and comply with literally thousands of different payment rules. Private insurers spend only 80 cents on each dollar for health care, while Medicare spends 98 cents on the dollar actually taking care of patients.
For those who care about the policy details of the health reform bills, this story is a trial balloon in the insurance industry's endgame -- they're already confident that we're all going to be required to buy their products, they know the public option in all the House bills is pathetically weak and likely to get weaker, and are now going for the pot of gold -- control of doctors and hospitals.
I'm no great fan of doctors as an institution -- politically, the AMA has pitted itself against patients for years, buying into the idea that docs are small businesses and not healers. But watch out for a last minute proposal to "incentivize" insurers to try to pay doctors flat fees up front to manage populations of patients (capitation).
This isn't a horrible idea in a non-profit universal system. Hell, in Great Britain doctors are salaried. But in the hands of private health insurance corporations, it will mean even more mass death at the hands of corporate bureaucrats than we face now. This is one of the tools they'll wield to evade the new, supposedly tougher regulations on things like pre-existing conditions.
The media have been about five steps behind the insurance industry through this entire debate.