Can paying doctors more cut the overall cost of healthcare; one doctors perspective and comments from the healthcare battlefield. Every day, the newswires are filled with articles discussing the cost of care, however, most of them give us statistics and observations instead of substance. How did we get here? The United States has the highest cost of healthcare in the world, with also the highest cost of school for healthcare practitioners, that of course needs to be paid back in some fashion. To put the cost of this education in perspective, check out this chart (http://www.kevinmd.com/blog/2014/05/pay-french-doctor.html). All the slogans and political statements about healthcare costs in the world cannot extinguish the fact that your doctor who has spent years in school is paying the equivalent of a mortgage payment to make good on the loans they required to complete their schooling. The problem of the cost of school is not just for doctors, but for all students, and the president last week signed a bill that would limit the total amount a former student would have to pay back to 10 percent of their income, which is similar to a policy that exists in Australia I believe. The problem is that there is no mechanism to allow economics to lower the cost of healthcare, so the cost of education is bound to continue to rise, which will likely require a bailout similar to what happened with the housing crisis of 2007. Of course, we need an intelligent solution and this is not it. About 40 years ago, patients had relationships with their doctors which has been mechanized in such a way that your doctor is likely to spend 10 minutes with you because that is all they can afford to do as they insurance companies starve them financially, while paying exorbitant costs for tests. They have no problem paying for hospitalizations and over testing, rather than paying doctors to do their jobs, and allowing them the time to properly figure out a patients problems. In our office, we are paid less than we were by most carriers 12 years ago, so we figured out a model that allows quality care with a lean and mean office that relies on systems that work instead of tons of staff. Your local internist can also function this way, except that nurse practitioners and other extenders have high costs of their education and as such, they are paid higher salaries, making it difficult for primary doctors to earn a good living. As such, many hospital systems are now poaching them as they expand to help doctors negotiate better fees as a part of their group. Meanwhile, because the specialists are paid more, for not necessarily doing more, and the primary doctors are underpaid, they simply refer them from specialist to specialist, who is happy to take your insurance or Medicare payments even though it is an inefficient way to find a solution or cure to your problem. The insurance carriers are clearly part of the problem, as they have helped develop these perverse incentives. Our system needs a reboot. In my opinion, we should be single payer. Not everyone agrees, especially after the recent problems in the VA. The VA was simply underfunded as we underestimated the cost of interfering with other countries by messing with their sovereignty, a bad memory of the Bush administration. Single payer does not mean our countries system would fall apart; however, it would correct a 40 year detour into private enterprise profitability that has made healthcare in this country more expensive, and less satisfying than many other countries, while putting tons of folks like you and I in debt with higher out of costs, deductibles and insurance premiums that go up faster than the cost of care. I found this on the web site Kevin M.D. regarding the cost of care and in my opinion, he is not wrong and in many ways, we are indeed similar in our practice habits. Check it out here AFSHINE ASH EMRANI, MD | POLICY | JUNE 14, 2014 Overwhelmingly, doctors' reimbursement has been the target of government programs and insurance companies. The idea underlying this movement has been, pay doctors less and curtail their incentive to see patients and the cost of medical care will decrease. As a result of this faulty reasoning, we have ushered in the era of unhappy doctors, those retiring early, and those asking for extra payments to justify the hours needed to give proper care to the increasing aging and complicated patients. Three decades ago, the diagnostic and therapeutic options were limited. We are now armed with real ammunition to fight off cancer, keep diabetes under control, avoid recurrent hospitalizations for heart failure and cure many infections in the office setting. The largest cost of medicine occurs in hospitalization. A single emergency room visit often costs more than the outpatient care of an individual for an entire year. A few years ago, I noted this backward mentality and set up the following systems in my office, effectively working as an urgent care, in addition to providing the usual preventative visits. read more