Tuesday, November 08, 2011

What the guilty verdict in the Dr. Conard Murray case tells us about Medicare

I feel sorry for Dr. Conrad Murray. With crowds of Michael Jackson fans cheering like the crowd at Place de la Concorde whenever a head rolled during the French Revolution, Murray was found guilty of involuntary manslaughter in the death of Michael Jackson, according to the Orlando Sentinal, which was reporting on the TV reporting.

(It’s a sad state of affairs when newspaper staffs have been decimated so badly to cut costs, that in a breaking story of national interest, the reporter covering the story can only tell you what he saw on TV. But that’s for discussion some other time.)

No, I don’t think Dr. Murray deserved to walk. Nor should he keep his medical license if he used it to support the demands of a performer who was, essentially, a prescription drug addict. All the same, I think Murray was a victim of the job (which he chose for himself), rather than any kind of malevolent medic.

One of the facts that emerged from the network coverage was that Michael Jackson paid Dr. Murray $150,000 a month. If you haven’t done the math, that comes to $1.8 million a year. That’s quite a premium given that the median income for cardiologists in the United States is about $219,000-and-change, and even the most successful cardiologists max out somewhere around $450,000 a year. Or at least so says Healthcare Salary Online, which gets its numbers from the U.S. Bureau of Labor Statistics.

By comparison, Dr. Murray was getting paid like an investment bank bond trader on a rocket-powered trip to the financial stratosphere.

Which brings us around to Medicare

Thanks to our skinflint, anti-entitlements Congress, Medicare reimbursements for doctors are pathetically low. The Republicans in Congress have every intention of pushing them lower still, in an effort to destroy Medicare.

Consider the cost of training a doctor: A doctor has to do well at a good four year college, which can leave him or her in debt for $200,000 or more in college loans – and then go on to medical school for four years. Figure medical school at twice the cost of college.

After that, there’s a year of internship, a year or more of residency, specialty training, endless continuing physician education, the cost of setting up an office with all the high tech equipment it takes to practice cardiology these days … well, you get the idea. It takes many doctors years to get to the point where their loans are paid off and they can begin to have a life.

Forcing doctors out of Medicare

The truth is, this nation should be paying doctors the way we pay bankers, and bankers the way we pay shoe salesmen. By putting the financial squeeze on doctors in the name of cost-saving, Congress is forcing more and more doctors out of the Medicare system. These days, the first time senior citizens call a doctor for an appointment, they usually have to ask if the doctor even accepts Medicare. More and more don't. You can thank the Republicans for that.

Between the ever increasing cost of a lengthy medical education, and the steadily eroding reimbursements both from Medicare and private insurance companies, it’s little wonder that some doctors start refusing to take Medicare. Or insurance.

Enter "concierge medicine," the medical care hogs

Instead, some doctors join organizations offering concierge medicine, which are based in well-heeled towns like Greenwich, Connecticut, and charge a flat $5,000 to $10,000 a year (depending on the applicant’s current age and heath.) Concierge medicine offers basic medical services, appointments on short notice, and even house calls in some cases.

A successful doctor practicing concierge medicine will take care of many fewer patients and earn up to 60 percent more than colleagues who take Medicare and other insurance reimbursements.

So instead of earning $219,000 a year, or maxing out around $450,000 a year if you're a top doc, a run-of-the-mill cardiologist can earn $464,000 – considerably more than his or her highly paid counterpart. Which would you do if you were a doctor?

Exactly. And that’s why there are fewer and fewer really superb doctors accepting Medicare. This is putting medical stress on 99 percent of the population while the top one percent calls a concierge doc for a case of the sniffles and demands that the doctor come right over “because I feel too achy to come into the office.”

But even more piggy of medical services than concierge customers, a few of the super-super-rich, Michael Jackson for example, become the sole employer of a doctor. The doctors travel with their patients and the patientss families, administering to their aches, pains, immunizations – and occasionally, as in Dr. Murray’s case, feeding their addictions. And here, too, one can sympathize with the doctors.

When doctors become slaves of their only patient

If you’ve given up a normal practice for a chance to make big bucks for a single patient, that patient owns you. Refuse some nutty or drug-addled demands, say for Profocol, and you could be out on your butt, your income down from nearly two million bucks a year to zero, with little prospect of similar future employment. So the tendency is to give the patient whatever the patient wants, even if it’s dangerous or against the law.

The Murray case should serve as a warning about single-patient medicine not only to other physicians, but also to the rest of us. Society needs to pay doctors enough to reward the cost, hard work and time it took them to become doctors and specialists. If Medicare doesn’t do this, pretty soon there won’t be any Medicare.

But doesn’t Medicare have to cut costs?

No, not the cost of paying doctors (or for that matter, hospitals.) If need be, uncap current Medicare payroll deductions to help pay the freight. And if we have Medicare for all, the cost per-patient will go down, simply because younger Medicare recipients will need less medical and hospital attention than the 65-plus crowd.

That’s why the “public option” that President Obama walked away from was so important, and why his abandoning it was so unforgivable.

As for the Republicans who would destroy our healthcare system and leave in its place healthcare for the rich only, they are beneath contempt.

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