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Paul Hochfeld is an emergency room doctor based in Corvallis, Oregon.
He
has just finished a documentary about the nation's health care system.
It's
in sixteen chapters.
And
it's up on the web at ourailinghealthcare.com.
In
it, Hochfeld analyzes major aspects of the health care system - technology,
liability, the pressure for profits, the change in the culture, primary care
crisis, and insurance.
In
the end, he comes down strongly in favor of a Canadian-style single payer, Medicare-for-all
type insurance system.
The
majority of doctors support single payer.
The
majority of the American people support single payer.
And
the majority of health economists support single payer.
Then
why isn't single payer the law of the land?
Hochfeld
cites the usual culprits - the health insurance industry and the pharmaceutical
industry.
But
then there are the not so usual suspects.
Like
AARP.
"AARP
is the enemy," Hochfeld says bluntly. "They spend a lot of money
on public relations trying to look like they are the good guys. They are part
of a PR coalition - Divided We Fail. And yet they lobby and lobby and
lobby and lobby in every state. In Oregon two years ago they threatened that
if Medicare were put on the table in health care reform, our local legislators
would lose their jobs."
"AARP
has a for-profit side and a not-for-profit side. Their for-profit side brings
in a big chunk of their annual revenues. They allow insurance companies to use
their name - because they have the greatest brand name of any in the county
- even better than Nike or Coke."
Another
major problem Hochfeld identifies in the movie - the paucity of primary
care doctors.
Hochfeld
says a third of doctors are primary care docs, while two thirds are specialists.
He
wants to reverse the numbers - two-thirds primary docs and one third specialists.
In
the movie, Hochfeld features a chart showing doctor salaries.
Primary
docs come in at an average of $178,000 - while specialists make twice
as much.
Hochfeld
says he has been criticized by other doctors for including the chart in the
movie.
Why?
"Physicians
are embarrassed by it," Hochfeld said. "Physicians are concerned
that the public will look at how much family doctors are making and say -
what are you guys whining about?"
"But
these specialists make so much more than primary care providers," Hochfeld
said. "We are losing primary care providers. If I were the czar of the
health care system, our single payer would do something about medical education.
I would say that medical school is free for everybody, including nurse practitioners.
I would tell these prospective medical students that if they want to go to medical
school, they are going to have to spend three to four years in public service
to repay their free medical education. They would come out of medical school
without this huge debt of $150,000 to $200,000. And they would taste the satisfaction
of being a primary care provider for a period of time. And I would also do something
about these reimbursement rates. I would tell doctors that if they wanted to
make more than some arbitrary amount of money like $350,000 a year, they should
do something else. When I have suggested this salary cap, there are physicians
who just get livid. They say - you can't do that, look how hard we worked,
look how much time we spent in school. And $350,000? You just can't do that."
"I
say - $350,000 is an unfathomably large amount of money for your average
person. And I don't think we would have any difficulty in getting people to
go to medical school with a salary cap of $350,000."
"The
reason we need the cap is to redistribute physician income. I'm not talking
about spending less on physicians in total. We just need to close the gap between
the primary care doctors and the specialists. And it's not just about money.
It's about quality of care. Because we are losing primary care doctors so rapidly,
the care people are getting is increasingly fragmented. People don't have primary
care doctors. And the sicker they get, the more primary care doctors marginalize
their care, partly because they are so busy because there are so few of them."
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Paul Hochfeld is an emergency room doctor based in Corvallis, Oregon.
He
has just finished a documentary about the nation's health care system.
It's
in sixteen chapters.
And
it's up on the web at ourailinghealthcare.com.
In
it, Hochfeld analyzes major aspects of the health care system - technology,
liability, the pressure for profits, the change in the culture, primary care
crisis, and insurance.
In
the end, he comes down strongly in favor of a Canadian-style single payer, Medicare-for-all
type insurance system.
The
majority of doctors support single payer.
The
majority of the American people support single payer.
And
the majority of health economists support single payer.
Then
why isn't single payer the law of the land?
Hochfeld
cites the usual culprits - the health insurance industry and the pharmaceutical
industry.
But
then there are the not so usual suspects.
Like
AARP.
"AARP
is the enemy," Hochfeld says bluntly. "They spend a lot of money
on public relations trying to look like they are the good guys. They are part
of a PR coalition - Divided We Fail. And yet they lobby and lobby and
lobby and lobby in every state. In Oregon two years ago they threatened that
if Medicare were put on the table in health care reform, our local legislators
would lose their jobs."
"AARP
has a for-profit side and a not-for-profit side. Their for-profit side brings
in a big chunk of their annual revenues. They allow insurance companies to use
their name - because they have the greatest brand name of any in the county
- even better than Nike or Coke."
Another
major problem Hochfeld identifies in the movie - the paucity of primary
care doctors.
Hochfeld
says a third of doctors are primary care docs, while two thirds are specialists.
He
wants to reverse the numbers - two-thirds primary docs and one third specialists.
In
the movie, Hochfeld features a chart showing doctor salaries.
Primary
docs come in at an average of $178,000 - while specialists make twice
as much.
Hochfeld
says he has been criticized by other doctors for including the chart in the
movie.
Why?
"Physicians
are embarrassed by it," Hochfeld said. "Physicians are concerned
that the public will look at how much family doctors are making and say -
what are you guys whining about?"
"But
these specialists make so much more than primary care providers," Hochfeld
said. "We are losing primary care providers. If I were the czar of the
health care system, our single payer would do something about medical education.
I would say that medical school is free for everybody, including nurse practitioners.
I would tell these prospective medical students that if they want to go to medical
school, they are going to have to spend three to four years in public service
to repay their free medical education. They would come out of medical school
without this huge debt of $150,000 to $200,000. And they would taste the satisfaction
of being a primary care provider for a period of time. And I would also do something
about these reimbursement rates. I would tell doctors that if they wanted to
make more than some arbitrary amount of money like $350,000 a year, they should
do something else. When I have suggested this salary cap, there are physicians
who just get livid. They say - you can't do that, look how hard we worked,
look how much time we spent in school. And $350,000? You just can't do that."
"I
say - $350,000 is an unfathomably large amount of money for your average
person. And I don't think we would have any difficulty in getting people to
go to medical school with a salary cap of $350,000."
"The
reason we need the cap is to redistribute physician income. I'm not talking
about spending less on physicians in total. We just need to close the gap between
the primary care doctors and the specialists. And it's not just about money.
It's about quality of care. Because we are losing primary care doctors so rapidly,
the care people are getting is increasingly fragmented. People don't have primary
care doctors. And the sicker they get, the more primary care doctors marginalize
their care, partly because they are so busy because there are so few of them."
Paul Hochfeld is an emergency room doctor based in Corvallis, Oregon.
He
has just finished a documentary about the nation's health care system.
It's
in sixteen chapters.
And
it's up on the web at ourailinghealthcare.com.
In
it, Hochfeld analyzes major aspects of the health care system - technology,
liability, the pressure for profits, the change in the culture, primary care
crisis, and insurance.
In
the end, he comes down strongly in favor of a Canadian-style single payer, Medicare-for-all
type insurance system.
The
majority of doctors support single payer.
The
majority of the American people support single payer.
And
the majority of health economists support single payer.
Then
why isn't single payer the law of the land?
Hochfeld
cites the usual culprits - the health insurance industry and the pharmaceutical
industry.
But
then there are the not so usual suspects.
Like
AARP.
"AARP
is the enemy," Hochfeld says bluntly. "They spend a lot of money
on public relations trying to look like they are the good guys. They are part
of a PR coalition - Divided We Fail. And yet they lobby and lobby and
lobby and lobby in every state. In Oregon two years ago they threatened that
if Medicare were put on the table in health care reform, our local legislators
would lose their jobs."
"AARP
has a for-profit side and a not-for-profit side. Their for-profit side brings
in a big chunk of their annual revenues. They allow insurance companies to use
their name - because they have the greatest brand name of any in the county
- even better than Nike or Coke."
Another
major problem Hochfeld identifies in the movie - the paucity of primary
care doctors.
Hochfeld
says a third of doctors are primary care docs, while two thirds are specialists.
He
wants to reverse the numbers - two-thirds primary docs and one third specialists.
In
the movie, Hochfeld features a chart showing doctor salaries.
Primary
docs come in at an average of $178,000 - while specialists make twice
as much.
Hochfeld
says he has been criticized by other doctors for including the chart in the
movie.
Why?
"Physicians
are embarrassed by it," Hochfeld said. "Physicians are concerned
that the public will look at how much family doctors are making and say -
what are you guys whining about?"
"But
these specialists make so much more than primary care providers," Hochfeld
said. "We are losing primary care providers. If I were the czar of the
health care system, our single payer would do something about medical education.
I would say that medical school is free for everybody, including nurse practitioners.
I would tell these prospective medical students that if they want to go to medical
school, they are going to have to spend three to four years in public service
to repay their free medical education. They would come out of medical school
without this huge debt of $150,000 to $200,000. And they would taste the satisfaction
of being a primary care provider for a period of time. And I would also do something
about these reimbursement rates. I would tell doctors that if they wanted to
make more than some arbitrary amount of money like $350,000 a year, they should
do something else. When I have suggested this salary cap, there are physicians
who just get livid. They say - you can't do that, look how hard we worked,
look how much time we spent in school. And $350,000? You just can't do that."
"I
say - $350,000 is an unfathomably large amount of money for your average
person. And I don't think we would have any difficulty in getting people to
go to medical school with a salary cap of $350,000."
"The
reason we need the cap is to redistribute physician income. I'm not talking
about spending less on physicians in total. We just need to close the gap between
the primary care doctors and the specialists. And it's not just about money.
It's about quality of care. Because we are losing primary care doctors so rapidly,
the care people are getting is increasingly fragmented. People don't have primary
care doctors. And the sicker they get, the more primary care doctors marginalize
their care, partly because they are so busy because there are so few of them."