It must be said

I see and hear various proposals about how to lower the increasing cost of medical care, and I'd like to take issue with one of them. Because if you think about it, it just doesn't make sense, although it sounds good at first.

Reformers propose that health care move away from a fee for service based system. They say that it causes docs to do unnecessary and expensive procedures. Instead, they prefer to pay for a better outcome.

Well, I'll allow that everything else being equal, if a given dollars worth of treatment results in a better outcome, and thus patients needed less treatment, particularly, less follow up treatment, that could save money. But not likely.

If fewer patients were going to doctors, the doctors would just see more patients and earn the same money. Overall we might have a more healthy population, but that wouldn't necessarily result in lower health care costs.

See, doctors are going to modify their behavior to maintain their incomes. If their incomes stay the same, health care costs stay the same. I think that a hard truth is that health care providers are going to have to be paid less. It doesn't make sense that a doctor can schedule 3, 4, 5 or more procedures (surgery,primarily) every day and charge $5,000 for each. $15,000 to $25,000 a day.

They work hard, their education is expensive and difficult, and they sometimes make people feel better. They deserve a good living. But something has to give.