By S.J., M.D.:
Concerning Dr. Gorback’s article: The Sheer Insanity of What You Pay For Medical Services
I am a family physician who has practiced 30 years and remain independent. In my central Pennsylvania town only about 5% of the doctors are not employed by a large health system. The “place of service” is yet another reason why private practice will be only for wealthy patients.
Oddly in our "free market," insurance companies and government have been made it difficult for independent docs to compete. This has occurred through a lengthy process of legislation and regulation that has almost always been to the advantage of these large systems and insurance companies. Now they are often at each other's throats.
But, they have found a way around that. In Pennsylvania, they have united themselves in at least two hybrid systems that are both insurance companies and health care systems. I am not sure why that does not meet the criteria for anti-trust.
I also do not know why Medicare has granted hospitals the ability to charge more for an employed physician doing a physical than the independent physician can charge in his office. Ironically, independent physicians doing physicals in the hospital will be paid less than he would in his office. This favoritism puts many Third-World countries to shame. It hurts our business community because of the lack of true competition thereby raising prices.
All of this has occurred with the cooperation of the AMA or any specialty society. These organizations have not only hurt their members, but have ultimately harmed most patients. This year I have noticed that there are many patients with high deductibles. They will forego simple needed tests because the costs are probably five times what they could be or wait until November to get them done at a much reduced rate through the Kiwanis club.