Anyone who has followed Dr. Tom Price’s public career has likely heard him deliver some variation on a cri de coeur he made at the beginning of his first confirmation hearing as the nominee to become Donald Trump’s HHS secretary:
During 20 years as a practicing physician, I learned a good bit about not just treating patients, but about the broader health care system and where it intersects with government. A couple of vivid memories stand out.
One [is] the number of times where patients were remarkably angry about the individuals figuratively, not literality, but figuratively standing between themselves and their physician in the clinic room. Making it so that what the physician was recommending may or may not be possible, whether it was from insurance or regulators or government or the like.
Indeed, the more you listen to Price (an orthopedic surgeon before entering politics) and many physicians like him, the more you realize that when they talk about “patient-centered health care,” they could just as easily say “doctor-centered health care.” In a culture where physicians are often given — and often expect — the respect normally owed to semi-divine figures, Price doesn’t really stand out. But it is interesting, if not surprising, to learn that even as the world focuses on the health-care-policy drama that has been playing out in Congress, Price has been busily fighting for the power and glory of his fellow doctors on a number of regulatory issues, as Erin Gershon reports:
Quietly, away from the spotlight cast on his effort to dismantle Obamacare, Price has been rolling back regulations that have been criticized by his former physician colleagues. And, unlike with the ACA, he has been able to do so without the blessing of Congress.
He’s given an American Medical Association committee even more power over how much the federal government pays for different medical services. He has pitched retroactively reversing certain Medicare rules to ensure some physicians no longer face penalties they would otherwise have had to pay. He has proposed using almost $1 billion in savings that would be achieved through cuts to certain hospital payments to boost spending on physicians.
And over and over again, he has delayed Obama-era regulations that would have penalized doctors who aren’t ready or able to move away from Medicare’s longstanding “fee-for-service” approach.
That may or may not mean better care for patients. But it certainly means more money and less “interference” for doctors — and higher health-care costs for everybody.
At a time when the entire political spectrum professes to believe that health-care-cost containment is hugely important to the country, that’s a problem. But Price, out of long habit, may be looking back and fighting old battles rather than looking ahead:
In many ways, Price’s regulatory changes represent a return to an earlier time. The Obama administration spent its final years trying to usher in a sleeker and more modern health care system — one centered on the use of electronic health records and focused on connecting the clinicians who oversee patient care across teams and entire hospital systems. It was driven by the belief that doctors should be rewarded for thoughtful, high-quality care — not for cranking out procedures in a “fee-for-service” system.
Price is ready to slam the brakes.
If you worry about whether your beloved physician is getting paid enough, or is sufficiently free to do things the way they’ve always done them, maybe Price’s old-school thinking makes sense. But in the end, real people pay when wealthy stakeholders fight progress. And they pay not just in dollars, but in the quality of care offered by providers who think they should never be held accountable by anyone else.
