Yet one more approach is being tested in Missouri, Kansas and Arkansas: While a doctor can't practice independently without completing a U.S. residency program, those states recently passed laws allowing foreign-trained doctors to practice under the supervision of a U.S.-trained doctor. This should also help to increase the supply of doctors.
The other major policy tool in reducing the amount we spend on doctors would be to reduce the use of medical specialists by changing the standards of care, the legal baseline that doctors and hospitals are expected to meet to avoid malpractice liability. This is largely a legal concept. While any licensed doctor can in principle perform any medical procedure, a family practitioner could be exposing herself to considerable legal liability if, for example, she gave a patient a heart exam that was typically performed by a cardiologist.
To get around this, it should be possible for doctors, hospitals insurers, and other providers to refer to the standards of care in other countries as a legal defense in malpractice cases. This would not be a protection against genuine malpractice; it would just mean that the use of generalists would not be evidence, by itself, of improper care.
There are enormous obstacles to any effort to reduce the pay of doctors. The restrictions that limit competition and keep physicians' pay high are mostly obscure and not even understood by many policy wonks. Any efforts to change them in ways that seriously threaten doctors' pay will encounter massive opposition from a very powerful political lobby. Furthermore, doctors generally enjoy a great deal of respect in society, and Americans tend not to think of their high salaries as part of the health care cost problem.
But if we want to stop paying a $100 billion premium for health care that doesn't make us healthier, we're going to need to overcome those political barriers. Getting U.S. health care costs down is a herculean task; getting doctors' pay in line is a big part of the solution. It's time we broke up the doctor cartel.
The fact that most people like their doctors will make the effort harder. Most of us like our letter carriers too, but that doesn't mean they should make $250,000 a year.
This article originally appeared on Politico.
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