Historically, the American Medical Association has opposed the federal government’s many attempts to expand healthcare to the masses. The AMA campaigned against Medicare, FDR’s efforts to include health insurance with Social Security, Harry Truman’s universal-insurance scheme, and Bill Clinton’s healthcare plans. The AMA has resisted experimental approaches to expand coverage and contain costs through experimental programs, like “pre-paid medical groups”.  Although this resistance has been defended as a matter of principle, financial self-interest clearly plays a role. No wonder doctors are more likely to be in the top one percent than any other occupational group.

The US has the highest paid doctors in the world. Even the AMA cannot deny this fact.  One reason is that, compared to other countries,  Americans received more care from specialists. Specialists are both expensive and not very good at managing chronic conditions, which are expensive to treat when they get out of hand (not to mention an important factor in the somewhat shorter life expectancy of Americans).  We need more General Practitioners! And they should be gatekeepers to specialized care – just like in Denmark.  

Some physicians have recommended paying GPs more to encourage medical students to go there. But our General Practitioners are already the highest paid in the developed world! What the US needs to do is institutionalize the GP’s gatekeeping role so that it’s standard practice across medical providers, increase the supply of GPs via immigration and training channels, eliminate fee-for-service incentives to test and treat more than necessary, and minimize defensive medicine by replacing our current medical malpractice system with something like Denmark’s national compensation program.

Yeah – it’s complicated, but that’s no excuse.

References:

http://journalofethics.ama-assn.org/2015/07/stas1-1507.html

How Doctors Could Thwart Health-Care Reform By James Surowiecki December 19 & 26, 2016 Issue of The New Yorker http://www.newyorker.com/magazine/2016/12/19/how-doctors-could-thwart-health-care-reform

How Denmark Dumped Medical Malpractice and Improved Patient Safety by Olga Pierce and Marshall Allen ProPublica, Dec. 31, 2015. Accessed 1/31/17: https://www.propublica.org/article/how-denmark-dumped-medical-malpractice-and-improved-patient-safety