Economics - General

“Health care, at any level, cannot be equated in dollars and cents.”

Dr. Bruce Douglas’s perspective on taking money out of health care:

“Health care is a ‘service,’ provided by health care practitioners, that does not belong in the competitive, so-called free enterprise marketplace. Of course, doctors have to be paid, but the payment should not come directly from the patient. Reception areas in doctors’ offices should be places where patients register for care, provide their insurance information, fill out a history form, and wait to be seen by their doctor. Receptionists should enter the information in a computer and be fed all the information that has been stored, privately, about that patient, that the doctor needs in order to give the patient undivided, preventive-oriented attention.  Money should not be mentioned, directly or indirectly, because health care, at any level, cannot be equated in dollars and cents.

Is this a realistic view for an effective health care system?  The patient doesn’t pay and the doctor doesn’t worry about cost?  Actually, yes…if the insurer limits the phyisicans choices regarding what is insurable.  In other words, this is managed care.  The patient pays nothing or little, the physicians can prescribe whatever they want regardless of price, but the physician choice is limited to treatments that are approved by the managed care organization.  However, Dr. Douglas does not support significant limitations on the physicians treatment choices.  He describes the the growth of HMOs as “rationing raised its ugly head.” 

If on the other hand, the doctor means that insurance should pay for whatever they want, doctors should prescribe whatever they want, and patients shouldn’t pay anything, well then this is a  recipe for significant cost inflation.  When insurance only covered severe hospital stay, patients would pay for most of medical care out of their own pocket.  If this was the case, then the doctor’s recommendations would be accepted or rejected by the patient based on affordability and other factors.  

Dr. Douglas’s solution is for a single payer system.  However, even a Medicare-for-all system will face the same dilemma.  Either, the single payer system will limit cost, but will have to ration care, or it will decide to cover all services but the cost of health care will increase.  


  1. That attitude is probably the single biggest factor in the high cost of health care in America. The other is the separation between payer and consumer.

    Ironically, Dr. Douglas’ philosophy makes our system more expensive on both accounts.


  2. Agree with m. By “protecting” the physician from the word “money” we don’t eliminate the economics of it. I’ve been a salaried physician all of my professional life. I still must ask myself, what is the value of my work? Does this doc who makes twice as much as I, do two times more “valuable” work? What is my “value” to my employer? to my patients? As perverse as the Medical market is I have to admit it probably does a better job of answering those questions than I.

    Likewise, I have to recognize that my patients live in the “real world” of dollars. That’s true with the uninsured (“Doc, I have to pay for this, is that test REALLY necessary?”), and for the insured (“That will be another $50 co-pay, is it necessary?”)

    And yes I’ve worked in a system with no payment whatsoever by the patients and with salaried docs. Money questions still get asked (particularly just before and just after the new budget year begins.)

  3. Of course the payment for health care should come directly from patient to health care provider. One of the primary drivers of skyrocketing health care costs is the fact that a 3rd party (the insurance company) pays for the patients health care. This is the exact opposite of trying to reduce costs.

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