Four out of five doctors

Normally we don’t talk about the letters to the editor. They’re just ordinary citizens, after all, and there’s no need to poke fun at them on the internet. But when the letter writer is someone important, that’s a different story. Today one finds a letter from the Chairman of the Board of the American Medical Association in the New York Times (which, by the way, has taken down or will take down the firewall protecting the brilliant work of Maureen Dowd and Tom Friedman). He writes:

>Your assertion that reducing physician income will significantly reduce health care costs doesn’t acknowledge that physician income only accounts for 5 to 10 percent of total health care spending (“Sending Back the Doctors Bill,” Week in Review, July 29).

>The American Medical Association agrees that strategies are needed to contain health care costs and achieve greater value for health spending. Health care spending has yielded substantial clinical, economic and quality-of-life benefits, but the overall growth in health care costs has outpaced general inflation.

>While physicians play a key role in efforts to contain costs, problems like obesity, tobacco use, alcohol, substance abuse and violence will require action by stakeholders from inside and outside the health care system to drive major societal change.

>With a predicted shortage of 85,000 physicians by 2020 and an aging population, we need to attract the best and brightest students to medicine. We must fix the flaws in our health care system, including ensuring that all Americans have health care coverage, reforming the broken medical liability system and stopping Medicare cuts to doctors that make it hard to care for seniors.

>Edward L. Langston, M.D.
>Chairman, Board of Trustees, American Medical Association
>Chicago, Aug. 3, 2007

He was on to something with the “significantly.” But if Dr. Langston had bothered to read the piece he takes issue with more carefully, he would have noticed that the argument did not concern the base income of doctors; rather, the author of that piece took issue with the method (and to some extent quantity) of compensation for the reason that it places incentives in the wrong places. So Langston ignores the core argument.

The funny thing–for me at least–is his turning attention away from the doctor’s fat paycheck to the doctor’s fat patient. Indeed, the man who needs to see the doctor is primarily the cause of the health care cost, and if he needs to see the doctor a lot (for reasons he can avoid) then even more so. But the percentage of health costs caused by the doctor rather than the patient was never the issue. It’s certainly distracting, however, to think about all of those fat patients. Almost makes you forget what you were talking about.