From the President...

Private Contracting --- Everyone's Answer to Medical Liberty

James P. Weaver, MD

Getting old has its problems. The only real blessing is that it usually happens slowly. For me, at 57 years of age --- I've been fortunate --- it's just really beginning to happen.

A few weeks ago, I visited my periodontist --- gum disease. I have a bad tooth near the back of my left upper teeth, and it needs some serious work. After she described the details of what she was going to do, I asked some appropriate questions including, "How much will it cost to fix that one tooth?" After a few silent moments of calculating, she calmly replied, "Oh, about $2,000."

I couldn't believe it. That seemed like quite a lot for fixing a single tooth. But just to get a comparison to the work I do, I went back to my office and asked my secretary to check into how much Medicare sends me for fixing an abdominal aortic aneurysm. Believe it or not, the number she came up with was $1305.00. I didn't think that was very much, and I think I'm right.

I must say that it was discouraging for me to hear that I will be charged $2,000 for fixing one of my teeth, but I can only earn a little more than $1,300 for fixing someone's abdominal aortic aneurysm. There is something fundamentally wicked and unjust about this situation. I think fixing an aneurysm seems as if it should be "worth" more than fixing one tooth; I don't care how much you do to that tooth. But I guess that's what the government's price fixing has finally done to physicians.

Because I am approaching the end of my career, I'm not too bad off with this government price fixing. Think about the residents in surgery, however, who have a full lifetime ahead of them of this type of government treatment. Imagine what their lives will be like?

Recently, the American College of Surgeons sent me their Bulletin with an article about the 1999 Medicare Fee Update. It is just about incomprehensible. It includes concepts like the MEI (Medicare Economic Index), and the "behavioral offset," and the SGR (sustainable growth rate), and of course the one we all know, the RVU (relative value unit). These are all rolled into the new "practice expense" and they come up with a figure that is about one-third to one-half the number that I believe would be a fair market price for the surgery I do. I think most surgeons feel the way I do about this. Mark my words, this price fixing is having, and will have serious effects on the practice of surgery in this country.

Physicians have been taken out of the "real world" of free markets. My vet charged me $85 a week ago to "examine" my cat, and there is no social history, occupational history, family history, or much of a review of systems to document. Other professionals are allowed to educate themselves, develop their skills, and "market their skills" in a free market; physicians are not. And the "allowed charges" for specialists are only going down.

I view my treatment, by our government, in this economic sphere as dismissive, demeaning, and degrading. Do physicians not have the same rights as other citizens? What does this do to the personal regard an individual has for himself, when he is forced to care for patients --- other citizens --- who could easily afford to pay a fair price for his services, but are protected from doing so by government edict? I believe the physician feels cheated "by the system," and that is not a healthy environment in which to practice medicine.

I have personally found it "easier," in this regard, to take care of the poor for free, than to take care of the well-to-do for the pittance that Medicare sends us for our labor. Whether or not we care to admit it publicly, or if we are capable of admitting it to ourselves, the government has made slaves of physicians. I do not use this term lightly.

Where will this lead? We are training fewer specialists now, and the baby boomers are headed for the Medicare "hand out." I predict that eventually, there will be an abundance of seniors, and a shortage of specialists all caught in this price controlled environment. Twenty years from now, if things don't change, the "difficult cases" will not be able to find a specialist who will provide them care. There will be too many of the "reasonable" cases around that will not involve the uncompensated time and energy required for a successful outcome in the "difficult" ones. That's human nature.

The way out is simply "private contracting." Allowing the elderly to pay for their services privately, outside of the Medicare system, will again place seniors in an arena which will truly guarantee them "access" to medical care. AAPS must continue to expose the government lie that it is giving the elderly "access" to medical care when it is apparent to those trying to work within the system that, by the government's oppressive manipulation of prices, they are only offering the illusion of that "gift."

Dr. Weaver is a thoracic surgeon in Durham, North Carolina, and president of the AAPS. E-mail: