CORPORATE CRIME REPORTER
Documentary
Doc Says AARP Is Major Impediment to Single Payer
23 Corporate Crime Reporter 1, December 29, 2008
Paul Hochfeld is an emergency room doctor based in Corvallis, Oregon.
He has just finished a documentary about the nation's health care system.
It's in sixteen chapters.
And it's up on the web at ourailinghealthcare.com.
In it, Hochfeld analyzes major aspects of the health care system – technology, liability, the pressure for profits, the change in the culture, primary care crisis, and insurance.
In the end, he comes down strongly in favor of a Canadian-style single payer, Medicare-for-all type insurance system.
The majority of doctors support single payer.
The majority of the American people support single payer.
And the majority of health economists support single payer.
Then why isn't single payer the law of the land?
Hochfeld cites the usual culprits – the health insurance industry and the pharmaceutical industry.
But then there are the not so usual suspects.
Like AARP.
“AARP is the enemy,” Hochfeld says bluntly. “They spend a lot of money on public relations trying to look like they are the good guys. They are part of a PR coalition – Divided We Fail. And yet they lobby and lobby and lobby and lobby in every state. In Oregon two years ago they threatened that if Medicare were put on the table in health care reform, our local legislators would lose their jobs.”
“AARP has a for-profit side and a not-for-profit side. Their for-profit side brings in a big chunk of their annual revenues. They allow insurance companies to use their name – because they have the greatest brand name of any in the county – even better than Nike or Coke.”
Another major problem Hochfeld identifies in the movie – the paucity of primary care doctors.
Hochfeld says a third of doctors are primary care docs, while two thirds are specialists.
He wants to reverse the numbers – two-thirds primary docs and one third specialists.
In the movie, Hochfeld features a chart showing doctor salaries.
Primary docs come in at an average of $178,000 – while specialists make twice as much.
Hochfeld says he has been criticized by other doctors for including the chart in the movie.
Why?
“Physicians are embarrassed by it,” Hochfeld said. "Physicians are concerned that the public will look at how much family doctors are making and say – what are you guys whining about?”
“But these specialists make so much more than primary care providers,” Hochfeld said. “We are losing primary care providers. If I were the czar of the health care system, our single payer would do something about medical education. I would say that medical school is free for everybody, including nurse practitioners. I would tell these prospective medical students that if they want to go to medical school, they are going to have to spend three to four years in public service to repay their free medical education. They would come out of medical school without this huge debt of $150,000 to $200,000. And they would taste the satisfaction of being a primary care provider for a period of time. And I would also do something about these reimbursement rates. I would tell doctors that if they wanted to make more than some arbitrary amount of money like $350,000 a year, they should do something else. When I have suggested this salary cap, there are physicians who just get livid. They say – you can't do that, look how hard we worked, look how much time we spent in school. And $350,000? You just can't do that.”
“I say – $350,000 is an unfathomably large amount of money for your average person. And I don't think we would have any difficulty in getting people to go to medical school with a salary cap of $350,000.”
“The reason we need the cap is to redistribute physician income. I'm not talking about spending less on physicians in total. We just need to close the gap between the primary care doctors and the specialists. And it's not just about money. It's about quality of care. Because we are losing primary care doctors so rapidly, the care people are getting is increasingly fragmented. People don't have primary care doctors. And the sicker they get, the more primary care doctors marginalize their care, partly because they are so busy because there are so few of them.”
[For a complete transcript of the Interview with Paul Hochfeld, see 23 Corporate Crime Reporter 1(11), January 5, 2009, print edition only.]
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