CullmanTimes.com - Cullman, Alabama

Health

December 13, 2012

COMMENTARY: To cut health care costs, pay doctors less

As Democrats and Republicans argue about how to spread the pain of health-care spending cuts, one group has been curiously excluded from the discussion: doctors. There's good reason to change that.

Everybody likes doctors. They deliver our babies, treat our ailments and often save our lives. In surveys of public trust, they rate higher than college teachers, police, even clergy, and vastly higher than journalists or politicians. Norman Rockwell painted doctors as kind, patient and wise. You probably hope your child marries one.

That public adulation is one reason why the 2010 health- care law, which imposed immediate and heavy cuts on hospitals, drugmakers and insurers, left doctors relatively untouched. A 1997 law that reduces doctors' Medicare payments is consistently overridden by Congress. And none of the proposals for entitlement reform now circulating around Washington calls for significant sacrifices from physicians.

It's worth asking whether doctors, who account for almost one-fifth of health spending, really need the special treatment.

After practicing for six years, the average U.S. family- medicine doctor makes $200,000; the average general surgeon, $350,000; and the average urologist, $400,000. (Spinal surgeons make $625,000.) Office- and clinic-based doctors are the most likely of any job category — except for securities and investment lawyers — to be in the top 1 percent of earners.

No other developed country pays doctors this much. In 2004, general practitioners in the United States were estimated to earn double — measured by purchasing power — the median for 21 nations in the Organization for Economic Cooperation and Development; for specialists, the difference was almost threefold.

Those earnings reflect higher payments per service. Last year, a routine visit to a U.S. doctor cost commercial insurers $89 on average, compared with $64 in Switzerland, $40 in Germany and $23 in France. For a normal birth in the U.S., doctors were paid an average of $3,390; in France they got $449. For a hip replacement, American doctors' average fee was $2,966, while in Spain it was $1,123.

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