I believe Rep. Pete Stark (D-Calif.) is past his prime noting his overgeneralizations, hyperbole and odd comments over the past five years (“Lawmakers say bill may lose negotiated payments,” Aug. 27). He did say “providers” and thus needs to segment those provider groups.
Hospital systems large enough to be considered oligopolies in many geographic areas have led to unbridled inflation in hospital costs because of the use of market leverage as opposed to free-market value to negotiate payments (rates). Antitrust principles have not been applied to this consolidation of hospital providers and thus consumers are paying more for their hospital care than their value would indicate. Hospital care is approximately 45% of the dollars spent on the cost of healthcare across both commercial and Medicare consumer segments.
I assert that the pot of money for physician providers is appropriate considering their extensive training with accompanying cost, their value to the American population and the intensity of their work.
Also consider that free-market dynamics (unlike lawyers) do not play a part of their overall contracted payment rates, especially from governmental-run health plans (Medicare and Medicaid).
Value is not measured on an individual nor collective basis. However, as payment methodologies evolved in our “system,” I don't believe anyone conceived of the diverse extremes of payment within the physician segment of providers with some specialists averaging 10 to 20 times the yearly earnings of others. The Relative Value Scale Update Committee, also known as RUC, and its association with the CMS has exacerbated this issue and reform is needed if we agree that re-emphasis on a healthy primary-care specialist is required long term for both system cost and quality reasons.
Primary-care “rebirth” cannot happen in a vacuum by ideology alone, but will require a reallocation of monies within the appropriate pot of money now going to all physicians. Currently we are experiencing the impact of self-interests overriding common sense to the detriment of the American people.
If cost is an issue, and I assert that it is, we must return (where other Westernized countries are at) to a 75%-25% ratio of primary-care specialists to other specialists and payment reallocation reform is the linchpin of such reform. Collectively, physicians are still in the 95th percentile of all American earners and deserve it given the requirements above.
Robert Forster, M.D.Rancho Cordova, Calif.