Commentary: Oh, for the days of Dr. Welby
When our longtime family doctor retired in the early 1960s, he was, according to my mother, charging the same amount for an office visit as he did in the 1930s when she and my father first became his patients. I always thought that was a bit of an exaggeration and it probably was but not much of one. The routine visit still hadn’t reached $10.
The health care cost comparisons of yesterday and today were brought home sharply by the discovery of the obstetric bills for the birth of my first two children two years apart in 1961 and 1963. The charges for pre- and post-natal care were a whopping $160 for my son and $150 for my daughter. The $10 difference for the boy was for a surgical procedure. Combined with a three-day stay in the hospital for their mother, the total for each was $300. Wow, that much!
A friend told me that as a 16-year-old, he would drive his doctor father on his house calls, many in poorer neighborhoods in their New England city. Before they would start out, the father would stop at a local store and load up the car with groceries that met the dietary requirements of his patients who couldn’t afford them. Rural patients, my friend said, often paid in produce and eggs and so forth. His father developed a heart problem from the stress of his practice and died in his 40s, leaving my friend and his mother with hardly enough to bury him.
These examples, of course, came before the government got into the health care business in 1965 and most Americans went to one doctor for nearly everything, even minor surgery. A distinguished surgeon at Tulane University reminded me of this recently, noting that the “general practitioners” when we grew up were not just referral services so many are today.
The newly released figures on the horrendous amounts being paid by Medicare to some doctors brought new perspective to what has happened to the cost of medicine and to the image of the benevolent doctor of my parents’ generation. Amazingly an eye doctor was paid $21 million in one year. How could he handle that many patients? Ophthalmology, it seems, is the most lucrative specialty, apparently because of the high cost of treating macular degeneration or cancer, especially among the aged.
Some 3,000 ophthalmologists received $3.3 billion of the $77 billion paid out to doctors in 2012, according to an analysis by The New York Times. Well, pretty soon, as the late Sen. Everett Dirksen said, “we’re going to be talking about real money.”
In fairness, a whole lot of the 880,000 doctors and medical service providers who accept Medicare didn’t do quite so well — not bad, mind you, just not quite up to the 2 percent who made almost one quarter of the total amount. One hundred doctors alone in 2012 took in a nifty $610 million, according to the Times. These figures are so startling as to leave one as breathless as a person on the verge of a heart attack. It is easy to see why Medicare has been reluctant to release them and the American Medical Association has opposed their disclosure.
A study in several western states of physicians’ payments under Medicaid, the state and federal shared plan for the indigents, showed that doctors who had been making no more than $15,000 annually were paid as high as $300,000 in the first year after 1965 when the program was adopted along with Medicare. Several doctors complained that their income was private. My response was obviously that the portion of money paid out of taxpayer funds was the public’s business. I feel the same way about Medicare.
What all this says about where we are headed in the not too distant future as we approach universal health care to 350 million Americans and still having enough money left over for running the government is scary. I just saw a hospital/physicians bill for an emergency abdominal surgery and 10-day stay that was $182,500. I had never seen a bill that high.
How far we have come since the passage of Medicare, when the estimates projected the ultimate cost of this entitlement would be $30 billion annually. Try 20 times that and still climbing.