Specialists are paid high fees to perform procedures. One stent may generate a fee of $1000-$2000 for a cardiologist who orders it, costing the system over $30,000 for that one procedure. Costs for procedures such as hip replacements and colonoscopies are similarly excessive, far higher in this country than any others. Specialists are not required to discuss actual risks and benefits with patients, and typically self-refer patients for these lucrative procedures without any stipulation that they are medically superior to less expensive alternatives. Contrarily, a doctor like me who can spend similar time grappling with complex medical and social issues with my patients, steering them on a rational medical course that is individualized to their wants and needs, will earn a tiny fraction of that fee. That is why only 20 percent of medical students are entering primary care and we are becoming a nation of specialists. Similarly, hospitals are paid well only if they hospitalize their patients; home care does not help their bottom line.

This perverse use of health care dollars is not difficult to fix. Doctor fees for visits and procedures are determined by the Relative Value Scale Update Committee, or RUC: a 31-person committee within the American Medical Association (AMA) that is specialist dominated and meets without transparency to determine doctor pay. With a single law that committee can be dissolved and doctor pay can be normalized, so doctors who think and converse with their patients are paid equally to doctors who simply do. Similarly, insurance companies such as Medicare can start paying equally for home care and hospital care so that both are feasible options. It is time we stop encouraging unnecessary procedures and hospitalizations through our insurance payment system, and start encouraging optimal medical care. That is what lies at the heart of our health care crisis, and fixing it will not only save Medicare and the ACA, but will save a lot of lives and give patients more genuine choices about how they receive the best care possible.   here…

Just fix the damn mess. I would like to be able to afford individual health insurance at least once in my lifetime.