Jeff,
I never said the current system works and I know of no surgeon who feels the status quo is acceptable. Most specialists do want change. What we don't want is More federal govt involvement. Medicare and Medicaid are not successful programs (poor reimbursement and runaway costs covered by taxpayers).
We don't make money "at the expense" of PCP's. Blatant lie. We all earn based on an RVU basis that has been adjusted many times in an attempt to better reimburse PCP's.
BTW our training is twice long as a PCP'S.
So what "high end" procedures do you want to ration? Do you have evidence that it will compensate for 30 million new patients wanting elective procedures?
No, it's a blatant truth. If we have X amount of dollars to spend on doctors in the US, and specialists get a disproportionately larger share than PCPs, then yes, you are earning more money at their expense.
In fact, the whole RVU system backs that up as you yourself state -- the rates for various procedures are stacked in favor of specialists. If this was market driven -- meaning that the patient and doctor agreed -- no problem. But it's not. It's a reimbursement scheme developed primarily by insurers, the doctors and government that heavily favors specialists (here in the US).
How much so? Last data I found showed PCPs making 170-180k average. Surgical specialists were mostly in the $500k range and up, meaning nearly 3 times as much or more.
Is this because an MRI an knee scope on a patient is more valuable than a 2-3 hour attempt to diagnose a condition like diabetes or fibromyalgia or so? Hard to say since the market isn't setting the prices.
Clearly doctors should be highly compensated, but what lacks intelligence is to say "give them whatever they want!" and then complain about healthcare costs in teh US. THAT is dumb.
And proof that curtailment and rationing of high end procedures will provide savings to staff and provide primary care for 30 mil newly insured?
It exists in every country in Western Europe, and Oceania. Health care costs per capita in those countries are generally 30% less than in the US with similar if not better results -- life expectancy, infant mortality, etc. How do they do it? Yeah, you wait for and may not get your knee scoped in all cases, and when you are in your 70s and 80s it may be impossible for you to get a heart transplant or a hip replacement. In return you get much better access to primary care at all times, and to specialist services when you are young and productive. Scream death panels all you want, but when you have a system where you spend something like 95% of all your lifetime health care costs in the last six months of life like we do in the US, primarily on specialists, you have a problem.
And that is why specialists want zero changes to the existing reimbursement system.