We operated on a patient recently from Pennsylvania who had first gone to see an orthopedic surgeon in his hometown who was a hospital employee.  The patient said that the surgeon didn’t seem to care one way or the other whether surgery was done.  He gave no guidance or advice to the patient.  He simply said “you can have surgery or not have surgery, it makes no difference to me.”

There was just one problem.  The patient had a symptomatic and torn meniscus in his knee which was preventing him from participating in his normal routine.  In other words, he was an obvious candidate for this very routine surgery, one which would represent a cure for this patient.  Why didn’t the surgeon recommend (highly recommend!) this surgery?  Quite simply, as an employed doctor he is paid the same whether he gets off of his rear end and operates or not.  He does not operate on a  fee for service basis.  He also doesn’t care.  He is paid the same whether he cares or not.  His income is not related to whether his waiting room is full.  He has no incentive, no skin in the game.

I am relating this story because I constantly read how the model of private practice or fee for service medicine in this country invariably leads to overutilization and the high cost of health care.  There are those who would like to see the private practice model of medicine (the only legitimate model with a relationship between a patient and their chosen physician) stamped out forever. 

Corporate interests in collusion with their bribed buddies in Washington drive this private practice extinction movement.  Former doctor, Bill Frist is the leader of this movement.  He has joined Tom Daschle in a bipartisan effort to support TUCA (the unaffordable care act).  I like Lew Rockwell’s definition of bipartisanship where the “parties get together to do something both stupid and evil.”

Former doctor Frist in recent comments has made clear his belief that private practice, fee for service practice is the primary driver of out of control health costs.  Frist and Daschle are stumping for mandatory insurance and support of the state exchanges, with their and their clients’ interests close to their hearts.  While in the senate, Frist was shameless in his support of legislation that supported his family’s company, HCA, Hospital Corporation of America.  Daschle….well…let’s just say he was generally shameless. Making slaves of doctors will make Frist’s HCA more money.  End of mystery.

Daschle and Frist are so ridiculously biased and compromised due to all of their “relationships” no one should begin to take any thing they have to say seriously when it comes to health care.  Check this article out.

The corporate influence on the practice of medicine is not a good thing.  It generates physicians who don’t care.  Our Pennsylvania patient’s experience demonstrates this although there are many examples of the same type of treatment.  Only when the physician is working for the patient and only in their interest is the likelihood of an honest patient doctor relationship maximized.  Any other arrangement is fraught with massive conflicts of interest, the patient inevitably suffering the consequences. John Goodman of the NCPA (National Center for Policy Analysis) writes an extremely hard-hitting piece in defense of the fee for service model and Frist’s arrogance here….it is Goodman at his best in my opinion.

Not convinced?  A hospital employed physician sees a patient and determines that they need their gall bladder removed and refers them to an employed hospital surgeon.  Did the hospital employee refer the patient to this surgeon because they work for the same hospital system or because that was the best surgeon for the job?  Think this primary care doctor has ever been talked to by a hospital administrator about the consequences to him/her of referring “outside of the family?”  This happens everyday.

Are there surgeons in private practice who act unethically?  Of course there are and the primary care doctors know who they are and refer nothing to them. …well…unless the surgeon is or becomes a hospital employee!   The straw man of perfection is not a realistic benchmark and no practice model can completely prevent unethical actors.  The proper and best benchmark can be found, however, by asking the economist’s favorite question, “compared to what?”

Compared to the model of fee for service private practice, all others fail to measure up.  It’s not even close.  The addition of price transparency brings in another element of accountability to private practice and renders the model as honest and ethical as it can get, I believe. 

Former senator Daschle and former doctor Frist are pushing for something else.  These men are hired guns, nothing but political gangsters, hired to do the bidding of the cartel bosses.

G. Keith Smith, M.D.