Dr. Tim Fixes the Healthcare System

Arthur “Tim” Garson Jr. wrote a piece for the USA Today explaining how to fix the healthcare system.  The title was Half of America skimps to pay for health care. The only fix is to cut waste and it is quite an interesting conclusion.  It starts out with:

In a new survey of 9,200 people across 15 states by my organization, the Texas Medical Center Health Policy Institute, 49% of respondents said they must cut other expenses to pay for health care. And they aren’t cutting back on frivolities like expensive electronics. Most often, they said, they had to cut back on their savings, as well as spending on food and clothing, to pay for health care.

The line that caught my eye is that people won’t give up on their expensive electronics.  To me, that is MAJOR!  He doesn’t even expand on the fact that people will do anything to keep their iPhones, Netflix, DirectTV, computers, laptops, and iPads.  But Dr. Tim goes on:

But the real shock was just how little respondents said they could afford to spend on out-of-pocket health care expenses. Well over 50% of the uninsured put that number at just 2% of their income. We saw a similar trend with the insured population, too. Almost half of insured respondents earning more than $100,000 said they could only afford to spend 2% of their income on additional out-of-pocket costs. Across the spectrum, it seems 2% is the magic number.

Does this mean people just don’t want to pay for their healthcare?  Maybe not.  It could mean that they are paying so much on insurance (which most of us have now due to Obamacare) they just don’t want to pay any more.  Dr. Tim ignores this and goes on:

Why does that matter? It sheds light on one of the most important provisions that the Affordable Care Act got so wrong. Obamacare defines “affordability” as 8.2% of income. Anyone who has access to a plan where premiums cost less than 8.2% of their income, and declines that insurance, must pay a tax penalty, known as the individual mandate. It’s a stunning disconnect. The government says affordability is more than four times what the people themselves consider affordable.

So, the public’s perception was never in line with Obamacare?  There’s a surprise.  Not.  That was what Obama’s administration was banking on.  Remember this?

“Lack of transparency is a huge political advantage,” the adviser, MIT health economist Jonathan Gruber, declared in newly unearthed video from an academic conference at the University of Pennsylvania in 2013.

“And basically, call it the stupidity of the American voter or whatever, but basically that was really, really critical for the thing to pass,” he added.

So what is Dr. Tim’s big fix now?  Cut the waste, which he believes is due to doctors being greedy.  Well, that’s interesting and an unbelievable reach.  Dr. Tim feels all doctors should be on salary and that will fix it all.  In fact, he thinks “payers such as Medicare and major insurers could offer bonuses to health systems that put physicians on salary.”  Wow, that sounds great.  Let’s give the hospitals and administrators the bonuses they save on doctors’ backs.

Arthur “Tim” Garson Jr. is a pediatric cardiologist, former medical school dean and director of the Health Policy Institute at the Texas Medical Center in Houston.   He is elderly and made his money, and a lot of it, a long time ago.  I just love when people who become wealthy decide that later on that they need to fix the same system that got them wealthy.  Hey, Dr. Tim, why don’t you give some of your money back?

Secondly, putting all physicians on salary means all physicians are owned by hospitals.  That is exactly what I am opposed to. I have lived it.  The marriage between a hospital and doctor is an unholy one and is filled with conflicts of interest.

Third, saying that the cause of such waste is due to physician incomes has been proven false over and over again. Don’t get me wrong, I do think the disparity in the income between some specialties is problematic but who do you think would be the first group salaried or cut in Dr. Tim’s plan?  Yup, the primary care folks.  They would find reasons NOT to touch the income of super-specialists like Dr. Tim was.  The administrators would make up a term like “outliers” or something like that and those docs need to be left alone as the hospital would be afraid they would leave.  Been there. Seen that. Over and over again.

So, in conclusion, people won’t give up their gadgets.  They pay too much for insurance and have little left for out-of-pocket costs.  And Obamacare missed the mark badly.  Therefore, according to Dr. Tim. let’s cut doctors income by making them hospital employees and putting them on salary.  Oh, and by every doctor what it really means is every primary care doctor.

Sound good?

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Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  11 comments for “Dr. Tim Fixes the Healthcare System

  1. Aaron M Levine MD
    October 25, 2017 at 1:02 pm

    When I was in medical school in the 60s, there were concerns about a doctor shortage. One means suggested was to get MDs out of administrative roles and return them to clinical practice. There were mini residencies advertised in JAMA for this purpose. I am not sure the new electronic journals kept the ads. The belief was that professional administrators would do a better job than a physician.

    I believe that it is Medical Economics that had a study where the majority of today’s residents expect to and want to be employed. They will have security. Look at the oil industry, NASA and air manufacturers, auto makers, etc. They all laid off their engineers when necessary.

    People forget, New York City had a house staff union in the mid ’70s and they went on strike. Further, there was a malpractice crisis and the private attendings had a boycott/strike for 2 weeks. So we can unify, but the motivation is not there.

  2. Pat
    October 24, 2017 at 11:11 pm

    I was so livid over this smarmy rat bastard, all I could do was write the moron editor that published his corrupt theorizing:

    To the Editor:

    The column by Arthur “Tim” Garson, MD on cutting waste in health care was as insulting as it was ill-informed.

    A retired specialist, academician, and self-appointed public health spokesman is a laughable choice to deal with this topic. This individual clearly spent a career becoming quite comfortable on the public monies and policies that have led to the disaster of health cost inflation. After years of selling out the autonomy of future doctors, he would now put us all on salary? Where are his admonitions to slash the enormous waste in paying legions of administrators, quasi-government JCHAO inspectors, and slashing burdensome Medicare/Medicaid regulations? Where was his call for sweeping tort reform to deal with the huge wastes in defensive medicine?

    No, Dr. Garson pushes the smarmy, know-it-all solution of looking at doctors as the cause of waste in health care spending. He is happy to appear in your pages as a wise old doctor, not taking responsibility for the mess that his generation left for the rest of us trapped in an increasingly blamed, and thankless profession.

    I would hope that Dr. Garson would be ashamed of his attack on colleagues, but comfortable retirement likely provides a pleasant buffer.

    Patrick Conrad, MD

    Yeah, spitting into windmills, I know…

    • Martha oreilly
      October 24, 2017 at 11:30 pm

      My thoughts but better written. Keep spitting

  3. RT
    October 24, 2017 at 10:09 pm

    Each Primary care MD, brings in $1.5 to 1.8 million annually to the “institution”. (http://www.healthleadersmedia.com/finance/primary-care-docs-average-more-hospital-revenue-specialists). Employing these MD’s secure these BUILT IN franchises. Question is, since we are the generators of $$$$, how much really are we entitled to vs that of the physician and non physician administrators? The current ACA will make it worst for MD’s. This is just the tip of the iceberg.

  4. SP
    October 24, 2017 at 6:10 pm

    this guy is a horrific sellout. It makes me embarrassed that he calls himself a pediatrician. However, I wasn’t sure I read the beginning of that article the way you did. I thought he meant that its not that consumers don’t want to cut back on frivolities like electronics, its that the cuts that patients make go deeper and are affecting basic necessities like food and clothing. electronics are not the only cut because they can’t cover their basic expenses let alone consider purchasing electronics. Call me an irritating idealist.
    But meanwhile, what about calling out Dr. Tim and finding out his “conflicts of interest” in writing a report such as this? Who is paying him, who has paid him in the past (?Is he a pharma floozy?) , and what ($$ or favors) will he get when he bestows his great wisdom on the unschooled public? That’s the way to shut these guys up. I worked in Houston years ago. The Pediatrics program is HUGE and the MEDICAL INDUSTRIAL COMPLEX is a thriving, pulsatile mass of greed and craven “academic” doctors getting paid in LOTS of undeclared ways. You know, the people who show up for grand rounds and their list of “affiliations and sponsors” takes up more than 2 slides…
    Not just a den of iniquity but possibly the Best BIGGEST Whorehouse in Texas

  5. Jerry S Purcell
    October 24, 2017 at 4:35 pm

    How do we, Dr. Tim, cut private MD salaries? Those that work for themselves? DO we ban that form of practice? Every doc must be an employed doc? Hail Caesar!!

  6. Martha Oreilly
    October 24, 2017 at 9:29 am

    Reading this article made me lightheaded with anger. It is Dr Tim’s generation of no MOC grandfathered doctors that made their dough milking the system, oversaw the loss of autonomy that has led to the virtual serfdom of the hospital employeed doctor and the denigration of primary care to the point that NPs are taking our jobs with a fraction of the training. I wish there was a polite way of telling this traitor to STHU he is doing more harm than good.

  7. Martha Oreilly
    October 24, 2017 at 9:27 am

    Jackass. It is his generation of no MOC grandfathered doctors that made their dough milking the system, oversaw the loss of autonomy that has led to the virtual serfdom of the hospital employeed doctor and the denigration of primary care to the point that NPs are taking our jobs with a fraction of the training. I wish there was a polite way of telling this traitor to STFU he is doing more harm than good.

  8. October 24, 2017 at 8:45 am

    Well, well, well, Dr. Tim…what about the insane profits that the insurance cartel, big pharma and the “not-for-profit” hospitals and health systems make? Does that figure in to your “solution?”

    I’ve got an idea. Why not expand the availability of and increase the contribution limits to HSAs, offer price transparency resources, make Major Medical policies available again and disintermediate healthcare?

    Maybe you should consider that. Or you could just get bent.

  9. Thomas Guastavino
    October 24, 2017 at 7:34 am

    Are there any physicians left out there that don’t see a desperate need for a physicians union?

    • Sir Hakum of Hugo
      October 24, 2017 at 6:13 pm

      A real Union would be fun. Imagine the CEO barging into the Doctor’s Lounge demanding more admissions. I’d love to look at him and say, “Talk to the shop steward, I’m on break, or “Sorry that’s not in my job description, look at the contract.”

      Imagine picketing. Imagine a Union’s health plan and pension. Imagine a Union preventing a hospital from bringing in unqualified scabs during a strike or any other time. The world of health care could really see what a real “Disruptive Physician” could be.

      I vote for the Teamsters…..

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