Trying to reform our nation’s train wreck of a health care system by throwing more money at it is like trying to put out a fire with gasoline. 

Here’s an article in the New York Times that nicely illustrates what I am talking about. It concerns the struggles of one man to maintain his income stream in the era of managed care.  

Dr. Donald Levin completed his training as a psychiatrist and opened a private practice in 1972, the heyday of “talk therapy.” Starting in 1985 he took a series of salaried positions at various hospitals, and in 2000 decided to return to private practice. Much to his chagrin, he found that the HMO’s were not willing to pay what he planned to charge.

And rightly so – study after study has shown that psychologists and social workers are just as effective as psychiatrists at talk therapy.  

Dr. Levin had a choice. He could have continued to practice the craft he had spent his entire adult life mastering, a craft he claims to love and to be good at. He could have acknowledged that he had been overpaid his entire professional life, and accepted the salary of a psychologist or a social worker (none of who, last time I checked, were living in cardboard boxes).  Instead, with the assistance of his wife (a licensed social worker), he organized his entire practice to maximize throughput.

The article explains: 

"Ms. Levin created accounting systems, bought two powerful computers, licensed a computer scheduling program from a nearby hospital and hired independent contractors to haggle with insurers and call patients to remind them of appointments. She imposed a variety of fees on patients: $50 for a missed appointment, $25 for a faxed prescription refill and $10 extra for a missed co-payment.

"As soon as a patient arrives, Ms. Levin asks firmly for a co-payment, which can be as much as $50. She schedules follow-up appointments without asking for preferred times or dates because she does not want to spend precious minutes as patients search their calendars. If patients say they cannot make the appointments she scheduled, Ms. Levin changes them.

"This is about volume,” she said, “and if we spend two minutes extra or five minutes extra with every one of 40 patients a day, that means we’re here two hours longer every day. And we just can’t do it."

Instead of treating 50 or 60 patients, in once-or-twice-weekly sessions of 45 minutes apiece, he now sees twelve hundred patients, for fifteen-minute sessions, once a month or less. When patients try to tell him about their personal problems, he cuts them off, telling them “I’m not your therapist.”

Dr. Levin told the reporter, “I had to train myself not to get too interested in their problems.” We wouldn’t want that, now would we?

Dr. Levin goes on to inform us, “I want to retire with the lifestyle that my wife and I have been living for the last 40 years.” He would not reveal his salary, but the article states that the median income for a psychiatrist in 2009 was $191,000.

But do we really need a guy making that kind of bucks if all he’s gonna do is rattle through a laundry list of questions during a perfunctory “meds check?” Dr. Levin himself states, “With medications, there’s not a lot to master.” My guess is that a nurse, or for that matter a computer algorithm, could do patients as much good – or as little good – as this guy is doing.  

“Nobody wants to go backwards, moneywise, in their career,” the good doctor explains.  “Would you?”

Indeed. And that’s what the rest of ought to say, when the government demands that we be forced to hand over thousands of dollars a year apiece to the health insurance companies, so that characters like Dr. Levin can continue to be supported in the style to which they have become accustomed.  

Photo via Wikimedia Commons