In response to the New York Times' “The $2.7 Trillion Medical Bill” (“Paying Till It Hurts” series, front page, June 2,)
Kenneth Prager, a professor of clinical medicine at Columbia College of Physicians and Surgeons, wrote the following short Letter to the Editor, which was published June 3 along with several others:
I suspect that if physicians were salaried there would be a substantial decrease in the number of medical procedures performed, including colonoscopies. Money has an insidious way of biasing medical judgment. When physicians profit from every procedure, it is too easy for some to justify it as in the patient’s best interest even when sound clinical judgment argues the contrary.
Second: There is a yawning and unjustifiable gap between payment for procedures and consultations. When I spend an hour to an hour-and-a-half with a patient who brings a stack of medical records and many imaging studies, I must often answer to Medicare for charging its highest consultation fee, which is but a fraction of the amount allowed for endoscopy.
Third: Overcoming an American culture that believes that more medical testing is better is a daunting challenge.
There is so much that is wrong with the byzantine and arbitrary way our doctors and hospitals are paid, and so many powerful entrenched interests arguing for the status quo, that it’s easy to be pessimistic about meaningful reform.
Englewood, N.J., June 2, 2013