ONE SOURCE OF BLOATED HEALTH CARE COSTS: PHYSICIANS

Fifteen to twenty years ago, I was walking in the medical center at the University of Rochester and I noticed a fat guy along with 2 others coming down the hallway. I noticed the fat guy because he was wearing a very nice tailored suit that made him look a little less like a bowling ball with legs and pumpkin head. As we passed, I heard him say something like "why should he have all the $300,000?"

I don't know if he was referring to income from practicing medicine but I started thinking that maybe some doctors are too concerned about making a lot of money. Some time later, I recall that a married couple, both of whom were physicians, purchased a huge $1,000,000 house and I was surprised that two people would want 28 or so rooms.

In The New Yorker, Dr. Atul Gawande suggests that part of the reason we spend so much on health care is that doctors see patients more as revenue streams instead of people needing the correct care:

“In El Paso, if you took a random doctor and looked at his tax returns eighty-five per cent of his income would come from the usual practice of medicine,” he said. But in McAllen, the administrator thought, that percentage would be a lot less.

He knew of doctors who owned strip malls, orange groves, apartment complexes—or imaging centers, surgery centers, or another part of the hospital they directed patients to. They had “entrepreneurial spirit,” he said. They were innovative and aggressive in finding ways to increase revenues from patient care. “There’s no lack of work ethic,” he said. But he had often seen financial considerations drive the decisions doctors made for patients—the tests they ordered, the doctors and hospitals they recommended—and it bothered him. Several doctors who were unhappy about the direction medicine had taken in McAllen told me the same thing. “It’s a machine, my friend,” one surgeon explained.