Now he’s done it. California Governor Arnold Schwarteneger has proposed a $12 billion program to require health insurance for all state residents, legal and otherwise. Putting the details aside, when a conservative Republican puts forth a social insurance plan that could dwarf social security, it’s news. And it’s about time.
We are witnessing the state’s moving forward with individual programs to protect their citizens as a prelude to a national health insurance program. Rest assured, this will not be a socialized system – no physician will be working for the government. That said, fees will be controlled to some degree, much the way Congress sets the Medicare and Medicaid fees (directly or indirectly through the states). The bottom line is this: the buyers of healthcare services are pushing back at fees, and they will come down.
So: younger physicians can expect to do well. Primary care physicians will probably see their incomes hold up and grow. Speciailists, particularly the top earning specialists, will see fees drop, sometimes dramatically. Incomes will also drop, but there are steps to take to soften the blow to incomes.If you haven’t watched the Michael Porter video (see my January 8 blog), then do so. Unlike other industries, there is no relationship between price and quality. I can get more information about the car I’m about to buy than I can about the physician I’m entrusting to find abnormalities such as, say, colon cancer. Meanwhile, the gastoenterologist who takes his time and finds potential problems that others, moving quickly, overlook – well, all the paid the same fee. There has to be some sort of financial incentive and reward for quality.
I can also see the problem. I bought a car last year that had a redeeming feature – cheap. New, but cheap. A few things broke, the brakes had to be replaced at 15,000 miles, it has poor acceleration – but it was cheap, and for this car, keeping overhead low was paramount. I can accept lower quality for a lower price and some minor inconvenience.
I can accept amalgam fillings in a cavity over a composite (tooth colored) filling. I can wait in a clinic to be seen by a resident. I can go to the “charity” hospital that was last remodeled after World War II. But the people – they have to be skilled, and they have to have the right equipment to do the right job.
I offer no answers here. I do offer the challenge – go for quality, go to be effectve. Your work should make a difference in the health and life of your patients, and in the end, you will be rewarded for this.