The Crooked-Doctor Component

While the nation suffers a political migraine over health care reform, today's news spotlights an overlooked aspect of the mess--that the current system is turning doctors into thieves.

Federal authorities yesterday arrested 30 physicians and other medical providers for $16 million of fraud as part of a series of crackdowns in what the FBI estimates to be between $60 and $100 billion a year of health care crime.

The healers this time are accused, among other neat tricks, of billing Medicare for liquid food provided to dead patients and $4000 "arthritis kits" consisting of braces and heating pads.

Such a financial and moral breakdown was dramatized in a New Yorker article last month that President Obama has made required reading in the Oval Office.

Written by a New England surgeon, Atul Gawande, it reports on the small town of McAllen, Texas, which has the second-highest per-capita Medicare costs in the country (after Miami) and twice those of neighboring El Paso with no discernible health benefits as a result of doctor-owned hospitals, surgery centers and diagnostic-test facilities.

This kind of borderline thievery transcends the question of public or private health insurance, calling into question the fees-for-service nature of American health care.

"Providing health care is like building a house," Dr. Gawande writes. "The task requires experts, expensive equipment and materials, and a huge amount of coördination. Imagine that, instead of paying a contractor to pull a team together and keep them on track, you paid an electrician for every outlet he recommends, a plumber for every faucet, and a carpenter for every cabinet. Would you be surprised if you got a house with a thousand outlets, faucets, and cabinets, at three times the cost you expected, and the whole thing fell apart a couple of years later?"

He points to alternatives such as the Mayo Clinic and other "accountable-care" systems in which doctors and hospitals "adopted measures to blunt harmful financial incentives and...took collective responsibility for improving the sum total of patient care."

In overhauling the system, he concludes, "the damning question we have to ask is whether the doctor is set up to meet the needs of the patient, first and foremost, or to maximize revenue.

"There is no insurance system that will make the two aims match perfectly. But having a system that does so much to misalign them has proved disastrous."

Meanwhile, the fraud and waste go on. The President should send copies of the New Yorker article to Congress. Reading it first will give them some perspective on the thousands of pages of the new bills they will be studying during their summer break.