Dr. J. is scratching his head. Before the seas were lowered, the skies cleared, and the heavenly hosts sang out, “Mmmm mmmm mmm, Barack Hussein Obama…” in celebration of The One’s jamming of Obamacare down our throats like an otorhinolaryngologist’s scalpel, we were told about the millions of citizens dying because they were uninsured (Insert ZOMG!!!!!!Eleventy!!!!1!11!!!!!TEH CHULDRENZ!!!!11!! here).

Now that the healthcare law has been passed and we had to pass the law to learn that a shortage of access was in it, the meme-weavers are spinning their webs yet again. Dr. J. brought up yesterday that Michael Moore is among the many pushing the Progressive talking points that waiting in breadlines doctors’ waiting rooms is not a biproduct of Stalin’s Five Year Plans Obamacare, but rather our patriotic duty, because we’re all in it together.

Breitbart brings us news of an article reportedly in the Journal of the American Medical Association, the house organ of the liberal AMA. The article may be in press, but it has not hit the interwebs as of this moment. So, Dr. J. can’t disect the article like one of his Wampa specimens.

From what it sounds like, Dr. Sirovich, an outcomes researcher at the White Mountain Home VA, an affiliate of Dartmouth School of Medicine sent out a survey to gauge the perceptions of primary care physicians with regard to their patient’s utilization of medical resources. This was a survey of 627 physicians.

About 42% of respondents, like Papa Bear, felt they were providing too much care to their patients. Issues that could have been addressed with an email or phone call were addressed in a face to face encounter.

About 6% of responders fell into the Mama Bear category, feeling their charges were receiving too little care.

About half (52%) of respondents fell into the little bear category and believed that their patients were getting just the right amount of care.

The areas being blamed for excessive utilization include fear of lawsuit, financial incentive in that one gets paid for an encounter but not a phone call, and if they provide their own diagnostic services (EKG, X-Ray, labs that are run in house for primary care providers and more advanced testing for specialists who were not part of the survey), they receive remuneration for these specialized services as well.

Now while it has been hard to prove that these carrots and sticks have an effect on physician behavior, it would be false to say that they definitively do not. Dr. J. works at an Ivory Tower Academic Medical Center and has spent some time at a government run health care facility affiliated with said Academic Medical Center. He has never spent time providing care in a private practice model, but he has friends that do. The truth is this, there are some rare bad apples out there that are not doing the right thing by their patients. They will order excessive tests for pure profit, and eventually they will be caught. There is a high profile case of this in Jackson, Tennessee right now.  But, the overwhelming majority of physicians are trying to do the right thing by their patients. It is well established that physicians do not conform to rational economic models, and this is because doing the right thing trumps any financial incentive. If doctors over order tests, especially ones that they read, it is because of their desire to confirm a diagnosis expeditiously and/or because it is the technology that they are most familiar with to answer the question. Dr. J. won’t deny that they are rewarded for ordering and interpreting that test, but, that is part of a proceduralist’s job. Think of how silly it would be if you were referred to a surgeon and he said, “I am the best gall bladder surgeon in New Atlantis, that is why you came to see me. Your gall bladder needs to come out, but I can’t do it because I saw you in the office. My partner who is pretty good will take it out.” You would go crazy! It’s the same with diagnostic testing.

What amazes Dr. J. is how academics and policy wonks are trying to come up with laws, regulations, rules, and firewalls in order to decrease utilization of scarce resources when there is a very simple solution to the problem.

Put the patient back on the hook for covering the cost of the treatment!

Now before you scream, kick, rend your hairshirt and say, “I haf no Dr. J.” Let him explain that he is not some heartless Scrooge.

When Dr. J. was a yout’ his old man had indemnity insurance as a benefit of his employment for an insurance company. We were responsible for the first $2000 and the company paid the rest. Dr. J. wouldn’t be taken to the pediatrician for every fever, or GI bug. Mom didn’t visit the internist for every ache or pain. A sprained ankle would not require an orthopedic consultation. We didn’t demand it because we didn’t want to pay for it unless it was absolutely necessary.

By way of contrast, Dr. J. and Mrs. Dr. J. both work for a living, and if the lil resident or lil med student even look at us funny, they’re off to the pediatrician because of the downside to missing work for either of us. If we can decrease their time out of school by a day it’s a big deal to us and to many other two income households.

If you had to cover the first $5,000/year out of your health savings account that you were permitted to roll over, you would be pretty judicious with regard to how it is spent. When you pay as much for a doctor’s visit as you do a latte at Starbuck’s, you are less choosy with regard to how healthcare dollars are spent.

Any good doctor welcomes a conversation with a patient when the patient asks, “Do I really need that test?” Truth be told, there isn’t enough of that because the economic relationship between the patient and their healthcare dollars has been totally short circuited.

Dr. J.’s solution the problem described by the survey is not to regulate doctors out of business, make patients wait in line, or create a socialized medicine program. It is to get rid of Obamacare, get rid of the restrictions on the products insurance companies can provide so they can sell products people want and can afford, encourage them to buy these products with tax credits/deductions. Permit individuals to save TAX FREE in HSAs that can be rolled over so that they can potentially self-insure their golden years.

In other words, the patient run healthcare is a far more desirable solution to the costs of healthcare than government run healthcare.

Dr. J.