A rambling but fascinating essay in the New Yorker on the business side of being a doctor. Great stuff (and no simple answers):
I remember, nine years ago, getting the bill for the heart surgery that saved my son?s life. The total cost, it said, was almost a quarter-million dollars. My payment? Five dollars — the cost of the co-pay for the initial visit to the emergency room and the doctor who figured out that our pale and struggling boy was suffering from heart failure. I was an intern then, and in no position to pay for any significant part of his medical expenses. If my wife and I had had to, we would have bankrupted ourselves for him. But insurance meant that all anyone had to consider was his needs. It was a beautiful thing.
Yet it’s also the source of what economists call “moral hazard”: with other people paying the bills, I did not care how much was spent or charged to save my child. To me, all the members of the team deserved a million dollars for what they did. Others were footing the bill — so it’s left to them to question the price. Hence the adversarial relationship doctors have with insurers. Whether insurance is provided by the government or by corporations, there is no reason to think that the battles — over the fees charged, the bills rejected, the pre-approval contortions — will ever end.
(via Kottke)