Nytimes looks at doctors' crucial role in reshaping U.S. health system

Doctors and hospital payment systems remain at the center of the health care reform debate as news outlets examine the benefits of replacing the current fee-for-service approach.The New York Times Prescription Blog reports: "In The New York Times Magazine on Sunday, economics columnist David Leonhardt poses one of the more disturbing questions of the health care debate: If politicians cannot fix America's fragmented, ailing health care system, who will? Physicians have reshaped medicine in the past, Mr. Leonhardt argues, and a few - like Dr. Brent James, chief quality officer of Intermountain Healthcare in Salt Lake City - already are leading the way to the future" (11/4).

The blog also provides a link to the full New York Times magazine article, which notes: "The health care debate of 2009 has had so many moving parts that it has sometimes seemed impossible to follow. The crisis behind the debate, though, is about one thing above all: the scattershot nature of American medicine. The fee-for-service payment system — combined with our own instincts as patients — encourages ever more testing and treatments. We're not sure which ones make a difference, but we keep on getting them, and costs keep rising." The article notes that these problems aren't likely to be fixed this year as a result of Congress' overhaul efforts. "And yet the modern history of medicine ...  offers reason for optimism. Medicine has changed before, after all. When it did, government policy played a role. But much of the impetus came from inside the profession" (Leonhardt, 11/3).

NPR reports on doctors' payments and the rising health care costs from the 1960s to the present. It also examines the reimbursement system created in the late 1980s when "an economist from Harvard, Professor William Hsiao, finally came up with method to determine competitive prices for doctor's care. Hsiao brought in doctors and asked them to rate every single thing they did based on how technically hard it was, how stressful, how much the supplies cost, etc. From this data, he developed the relative value scale. Medicare adopted the relative value scale in 1992, and it's still used today" (11/4).

Reuters reports on doctors' role in health care problems and the often irrational distribution of doctors as seen through healthcare data analyzed by Dartmouth Medical School. Reuters reports: "Access to top doctors, cutting-edge procedures and advanced life-saving technology has less to do with need and more to do with quality of life issues that any professional would consider when deciding where to live -- climate, schools, and perhaps most importantly, income" (Baltimore, 11/5).

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This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.