Doctors Don't Drive Up Costs: Poverty Does
Each is a fine, clear, and direct writer.
Recently Dr. Cooper made a presentation before an audience of physician workforce consultants at Merritt Hawkins, and I could not resist reprinting this piece by Phillip Miller. I often read Dr. Cooper’s blogs at buzcooper.com, and I recommend my readers do too.
Cooper turns the conventional wisdom of elite policy wonks on its head by saying, in essence, it isn't “overdoctoring” that drives up costs; it’s sick poor patients who show up in the later stages of their illnesses in economically unstable parts of the country – like the American South, remote rural areas. and inner urban cities.
For Miller and Cooper, poverty and economic instability i id a short, simple, and reasonable explanation for cost varations across the U.S.
That’s the only conclusion I believe a reasonable person can draw after reviewing the data and analysis compiled by Richard “Buz” Cooper, M.D., an oncologist and an internationally noted authority on physician supply and health care utilization studies.
In the run-up to health reform it was repeatedly stated by policy makers and analysts that $700 billion in health care spending could be saved if physicians would only practice like they do in the upper Midwest and other low cost regions. Control how physicians practice and you can control healthcare spending, is the underlying basis of much of today’s health care policy.
Though Dr. Cooper conceded there is ample waste and inefficiency in the health care system, he argues that it is economic disparity, not physician practice patterns, that drives health care utilization and therefore health care spending. Poorer people are demonstrably sicker and cost more to treat than do more economically stable people by a large margin. Therefore, the key to lowering health care costs is to reduce poverty and increase wealth. Standing over the shoulders of physicians telling them how to practice is not the answer.
This seems like a straightforward argument, but it is not one that is widely accepted in health policy circles, so perhaps I am missing something. Is the problem of rising health care costs derived mostly from how physicians practice, or mostly a result of economics? Or is there some other driving force? I would like to hear what you have to say on this topic and welcome your comments.