Having dispensed with the political inanity known as "Health Care", I would like to advocate for fixed but high remuneration to specialty physicians in a new Medical System in the United States of America. Does caring for an individual Multiple Sclerosis (MS) patient deserve more physician earnings if said patient requires more "pay dirt testing" than another MS patient?
The high stakes decision tree for the Immunoneurologist is multi-faceted and potentially loaded with clinical pitfalls. Some patients require more expensive testing, but less physician brainpower. In others, it's the reverse. This should translate into no difference in the MS doctor's remuneration. Some would even say that irrespective of the services, if the physician needs to invest more time in deciding what to do with a patient, that should carry the day in terms of "what the patient care time is worth".
Why do teachers favor multiple-choice exams? They're easier to grade. Why do third party payors reimburse more for testing? It's easier to assign an "objective value" based often on the complexity or cost of the test.
I'm not sure if this neologism will catch fire, but suffice it to say that whether we are dealing with "Health Care" (rather than the more rational category- "Disease Care") or "Big Pay Days for Excessive Medical Testing" or "Certain M.D.'s Getting Ultra-Wealthy Via Overbilling and/or Overtesting", we might apply the linguistically incorrect term "Moronics".
"Moronics" is the science of exploiting a broken "Health Care System" to allow for the conversion of select patients into cash cows. Also via "Moronics", other patients are left hanging in the lurch; they are unable to get proper care because they don't have an insurance policy that matches a particularly expensive disease they may have developed.
Look, I'm not advocating for the dismantling of our wonderfully high tech world of medical testing and treatment machines. I'm not suggesting we invoke the dreaded "S" word for Socialized Medicine- Iron Curtain Style. I am advocating for a way to allow for patients with a complicated disease such as MS to be cared for by doctors who should not make decisions on the same individuals based upon capitalistic motivation. If Mrs. X needs Tysabri, she needs it regardless of her insurance coverage. And she shouldn't have to be booked for another Brain Stem Evoked Response Test because Dr. Y needs to finance an upgrade in the waiting room furniture.
My suggestion is to guarantee high relatively fixed incomes for specialty physicians seeing large numbers of MS patients or other patients with complex illnesses. However, such M.D.'s would not be in the "MS business" and therefore would be disincentivized from running up the work-up tab on patients with great coverage or cooling their jets on interventions that "poor man's policies" don't cover.
Published On: January 31, 2008