large_9-20-09HealthyDebateThe Press Register has been full of Mobile physicians who now are willing to share the secrets of what we need to do to provide adequate health care coverage for the citizens of Alabama. From Saturday’s news comes the  results of a poll of the membership of the Mobile County Medical Society that identifies fear of lawsuits as being the number one reason that they practice expensive and not very effective medicine. The President of the group, local nephrologist Craig Kleinmann, said “fears of lawsuits force many doctors to take expensive precautions and order extra tests — often called defensive medicine — because they don’t want to be accused of missing something.”  A story in the Washington Independent on the other hand quotesTom Baker, a law school professor at Penn as saying that eliminating the ability to sue would only reduce costs by 1.5%. Ahh, but you say it’s not the actual costs, it’s the defensive medicine. Do physicians who profit off of ownership of diagnostic equipment do it for “defensive” reasons?

Then today Jeff Terry, a local Urologist, had his say. He believes that individuals will make dispassionate correct health care choices if only they were allowed. It is “government” that gets in the way. Interestingly, the New England Journal of Medicine also called for a retrenchment regarding health insurance reform. In looking at the administrative costs and physician incentive problems of the current system, they have called for a reconsideration of the single payor system. One or the  other of these folks must be correct.

It turns out, in Alabama we have come close to a single payor. For those without “government” health care, 90% choose Blue Cross. They are the provider of choice for 2.2 million Alabamians.

Mentioned in the President’s speech suddenly people are a lot more knowledgeable about Blue Cross of Alabama. They are a self described “not-for-profit healthcare company” whose goal is to return 100% of premium back to their client. This not seeking profits has led them to proudly state that over the last 10 years, Blue Cross and Blue Shield of Alabama’s profit has averaged 0.6% of total dollars received from our customers.

Blue Cross of Alabama recently discovered the incentives were skewed to reward specialists over generalists in Alabama. The company is doing the right thing and owning up to the fact. A Birmingham Business News review of some of the new reimbursement rates shows severe fee cuts for arthroscopic knee and shoulder procedures as well as colonoscopy and endoscopy exams. Reimbursements for each of those was cut by at least 16.6 percent with arthroscopic surgeons losing more than $200 per procedure.

I’m curious if the physicians who will take a significant cut will simply agree that the invisible hand has spoken and cheerfully take home less money.