Who is Responsible for Lowering Health Care Costs?

By Scott Hultstrand, SCMA General Counsel 

Finger pointing abounds right now in the national debate about who is responsible for rising health care costs.  Some of the finger pointing ignores the complexity of the problem, because in reality the blame should be spread amongst a myriad of stakeholders in the health care field.  And the likelihood is that one could use all the fingers on both hands to cast responsibility and run out of fingers before all “guilty” parties are implicated. 

I agree that it is important to dig up the roots of our cost crisis, but just as significant (if not more) is who will take responsibility for “re-planting.”  Will it be CMS?  How about big business?  Or patients?  Or the insurance industry?  At this point my guess is many of you are cringing at the thought.  However, based on a national survey of physicians published in this week’s JAMA, it looks as if physicians are loathe to take responsibility for fixing this mess we are in.  Of course, we can poke holes in the survey all we want, but with the robust response rate (65%) that was nearly spot-on in terms of representing the hoped-for sample population, the results should at the very least make us pause for reflection.

So what does the survey say?  When asked who had major responsibility to reduce the cost of health care, physicians picked trial lawyers as the number one “fixer of health care.”  Right behind trial lawyers was the insurance industry, followed by the pharmaceutical industry, hospitals, patients, and the government.  What about physicians?  Physicians finished 7^th, just ahead of physician professional societies.  Coming in last place were employers.  Do we really want trial lawyers and the insurance industry to be the primary problem-solvers in our health care cost crisis?

Now there could be a lot of reasons why only 36% of physicians believed they had major responsibility for reducing costs in health care.   And I can understand why trial lawyers and the insurance industry “won” the survey, since both of these entities have long been seen as the major roadblocks in the system.  Rather than spending our blog time psychoanalyzing physicians and why they responded as they did, let’s conclude with some thoughts about why in an ideal world the survey would have listed physicians as “Number One.”

Physicians both have better knowledge about how to reduce costs and better access to the point of care in terms of effectuating that knowledge.  Physicians are in a unique position to actually implement what they design since they are the ones who actually provide the health care.  Taking major responsibility for fixing the health care cost crisis does not mean we are to blame, but rather means that we are going to take charge because we are the most qualified.  The health care markets are in a “perfect storm” right now of a heightened sense of urgency mixed with nearly absolute uncertainty.  Who better to step in to calm the storm than physicians?  Physicians are positioned to reassert their authority and take back the clinical autonomy that has been stripped by the insurance industry, malpractice suits, and big government over the last few decades.   

In an accompanying editorial to the survey, JAMA contributors Ezekiel Emmanuel,MD, PhD, and Andrew Steinmetz conclude as follows:

The next decade requires “all hands on deck” to create meaningful, lasting change in health care. The [survey] indicates that the medical profession is not there yet—that many physicians would prefer to sit on the sidelines while other actors in the health care system do the real work of reform. This could marginalize and demote physicians. Physicians must commit themselves to act like the captain of the health care ship and take responsibility for leading the United States to a better health care system that provides higher-quality care at lower costs.

   

It’s time to stop the blame-game, and take small (but important) steps towards reclaiming the health care system for the ones who are most vital to it – the physicians and their patients.  One of those small steps could be to spend a few minutes each day learning and reflecting on the changes that are happening.  Another small step could be to think about how innovative ideas you have come up with in your personal practice could be spread to a larger context.  This SCMA blog and our Journal are two ways to do just that!