Reform: Contrasting views from the medical field

Dr. M. Todd Williamson

Allow individual patient contracts with doctors.

I testified before Congress in June to provide a practicing physician’s perspective on health care legislation. The legislation would change our nation’s medical care system in dramatic ways. And, I believe, the cost would be enormous and the purported benefits are suspect.

That said, the Medical Association of Georgia (MAG) — which represents a diverse mix of thousands of physicians from across the state — believes that ensuring a patient’s right to enter into a private contractual agreement with their physician is the single most important step that lawmakers can take to reform the country’s health care system. And we are not alone. MAG was part of a coalition of 20 state medical and specialty societies representing more than 100,000 physicians that sponsored a resolution at the annual American Medical Association meeting in June that solidified a patient’s right to privately contract with his or her physician as an AMA priority.

Given this freedom, every patient would literally have access to every doctor. Those same patients could negotiate fees for their care on an individual basis. Doctors, meanwhile, would have the discretion to charge their full fee, a reduced fee or no fee at all based on individual circumstances — an option that is actually prohibited under the existing Medicare and Medicaid programs. This option would be forbidden altogether if the aforementioned legislation becomes law. Unfortunately, this kind of restriction reduces the access that patients have to medical care.

With private contracting, a patient’s unique health insurance coverage circumstances serves as the basis for the negotiation between the patient and the physician. Importantly, individual patients get to decide on the medical care that’s best for them and their families. Medical decisions should be made by a patient in concert with their physician — not by the federal government, which already has too much power given its role as the single largest payer of medical care.

Private contracting will promote transparency, accountability and cost control at the individual level. And given a greater personal stake, patients will be vigilant when it comes to detecting and preventing fraud and abuse.

This approach will additionally enhance access to medical care because every patient will have access to every doctor, keeping in mind that many physicians opt out of government-run health care plans because the pay simply does not cover the cost of the care. No one in any profession should be expected to operate at a loss, including physicians.

Private contracting will preserve the kind of patient-physician relationship that has served as the foundation for the best medical care in the world. The outcome for many types of cancer, heart disease, diabetes and high blood pressure is clearly better in the U.S. than in the rest of the world. Let the global community choose where they would receive their medical care, and people from around the world would line up at our borders.

As an added benefit, allowing patients and physicians to negotiate on a one-on-one basis will help the country achieve the fiscal results it desperately needs.

Allowing patients and physicians to enter into private contractual agreements should be the cornerstone of reforming the way we finance our medical care system.

We should empower individual patients to spend their own health care dollars and make their own health care decisions as they see fit — without constraint and regardless of third-party payers, such as Medicare.

Managed care and government payers have, over time, moved us away from free-market principles. As a bottom line, MAG believes that restoring a truly competitive environment (i.e., the right to privately contract) is the most effective and efficient way to preserve our health care system.

Dr. M. Todd Williamson, a neurologist from Lawrenceville, is the president of the Medical Association of Georgia.

Expand Medicare to cover the uninsured.

By Jack Bernard and Dr. Daniel Blumenthal


A Harvard study recently found that, despite the intense disinformation effort by those against change, Americans still view health care as one of their highest public priorities. Insurance premiums are going up four times as fast as workers’ wages, but only 28 percent of Americans rate our existing health care system as good or excellent. Our per capita health care spending is double that of any other developed country, while our health care system ranks 37th in the world, behind Costa Rica.

Yet, every day we view outrageous images of protestors disrupting town hall meetings called to discuss health care reform.

This campaign of disinformation is confusing our citizens and causing frightened members of Congress to kowtow to a shrill minority. The result is likely to be inaction, or a bill that makes only marginal adjustments to the current system. This will neither control costs (the top concern of most Americans) nor provide health care access for all (Americans’ second most important concern). What can be done?

The solution is clear: expand Medicare to cover everybody.

It is hard to attack a program almost everyone understands and that outperforms private insurance in satisfaction surveys. With universal Medicare, costs can be controlled, quality improved and access assured.

Almost every other developed country covers all its citizens with a program that resembles our Medicare, sometimes with supplemental private insurance.

In the U.S., we spend $6,714 per capita on health care annually, as compared to $3,040 in France, $3,371 in Germany, $3,678 in Canada and $2,999 in Australia. Yet all these countries have better morbidity and mortality statistics than we do.

We hear tales of foreigners who come here for medical care because of treatment delays in their home countries. Yet we rarely hear about the 750,000 Americans who went abroad for health care in 2007.

There are those who complain that the U.S. government cannot effectively run anything. Yet this is the government that put a man on the moon and operates the strongest military in the world. This is also the government that runs a health insurance program — Medicare — far more efficiently than does the private sector. Private insurance companies spend 20 to 25 percent of the premium dollar on marketing, administration, shareholder dividends and exorbitant CEO salaries. Medicare operates on an overhead of about 3 percent. The savings generated by changing to universal Medicare would literally be sufficient to cover all the uninsured.

Adding to the inefficiency of our system are the billing costs incurred by health care providers. Every hospital and medical practice must maintain massive billing departments to submit (and resubmit) claims to dozens of insurance companies with hundreds of different insurance plans. Providers in other countries typically need no more than a handful of billing staff.

Our system of providing very expensive private insurance through our employers has a deleterious effect on U.S. industry. American automobile manufacturers, struggling to survive, must pay insurance premiums for their employees. Their Japanese competitors do not have this burden. General Motors pays more for health care than for steel.

Medicare is an insurance program and all insurance programs, private or public, ration care to contain costs. The big difference is that Medicare must be responsive to the citizens because it is a public program. For example, because of public demand, Medicare added a prescription drug reimbursement benefit two years ago.

If we want to catch up with the rest of the world regarding quality, cost and access, let’s hope that more senators and representatives wake up before we are left with the status quo and our children have to deal with disaster.

Jack Bernard is a retired health care executive from Monticello. Dr. Daniel Blumenthal is associate dean at Morehouse School of Medicine.