What if We Didn't Pay Physicians at All?

April 5, 2013

Rather than pay docs fairly, we could create a monastic Physician Brotherhood, which would in turn receive goods and services for free.

In recent proceedings of a California court, focused on whether Medicaid reimbursements might be cut to levels below the break-even point for participating doctors, the Obama administration made a very telling statement: "There is no general mandate under Medicaid to reimburse providers for all or substantially all of their costs."

Then there's the National Commission on Physician Payment Reform, formed "to assess how and how much doctors get paid" as a result of perceived "escalating need to curtail rising expenditures on health care, of which the payment of physicians, and expenses controlled or influenced by physicians, are key drivers."

In other words, forget everything you may have heard about physicians' compensation accounting for less than 10 percent of healthcare costs. Disregard docs' virtual inability to get paid dime one for a diagnostic or therapeutic action unless payment is approved by a government bureaucrat or insurance company paper-pusher.

The powers that be insist that the major roadblock to a cheap and well-oiled healthcare machine is our greedy insistence on earning something for what we do.

I therefore suggest that we give society what it clearly wants from us, and cease requiring payment for services rendered. Worry not, I'm sure there will be enough people who still go into healthcare for "love of the game," and that they will continue to be the best and brightest who actually have the scraps to do a good job in the field.

There does remain the minor issue of how these selfless souls will achieve their basic needs of nourishment, shelter, etc. One colleague suggested shaving our heads, donning orange robes, and hoping that satisfied patients will throw some charity into our empty rice bowls as they depart our facilities. I don't think we need go quite that far.

Still, it does inspire a solution.

Since we are expected to behave like a monastic order, let's go whole-hog with the idea. It being unseemly for coin to sully our hands, the society which depends on our having no worldly temptations must tend to our needs.

When a physician calls his plumber for a burst pipe at 3 a.m., the service call gets as hasty and competent a treatment as would any other - but no payment is expected from the physician, whose services are of course at the disposal of the plumber and his family, gratis.

Same deal with the landscaper. And the electrician. And the grocery store.

"But wait," you say. "How can you be sure the entire store's staff will be seen by this one doctor? What if it's a chain of stores, across the country?"

No worries. After all, the Physician Brotherhood (call it the Scions of Apollo, or the Hippocratic Order if you prefer) encompasses all docs, so everybody in the supermarket chain will ultimately be seeing a member of the Brotherhood elsewhere. Anybody balking at giving a doc his free goods or services will swiftly find himself ineligible for medical care, anywhere, until he made good.

Just think: You'd never have to pick up a check in a restaurant again. Anything you want in a store-yours for the taking. There would have to be some rules established by the Order, to prevent allegations of abuse. Only one new car every five years, for instance. First-class plane seats only if there's a vacant one on the day of the flight.

Part and parcel of this model would be careful control of the Order's secrets. Namely, the practice of medicine. Only initiates, sworn to a lifetime in the Society, would be taught, with increasing levels of knowledge as they proved themselves. You know, sort of like residency. Thus, no fully-trained physician would exist outside of the Order, hence, no outsiders to serve as "experts" for prosecution of med-mal cases.

See? Working without being paid for it can be a good thing - and I haven't even touched on the fun stuff, like figuring out what our secret handshake will be.