Health care held captive

I read with interest the front-page story about Maryland’s attempt to control health care costs in an effort to retain its Medicare waiver (“Maryland works to bring doctors, nursing homes into Medicare cost control program,” Oct. 1). Much of the onus for the health care transformation emanates from hospitals, who have the most to lose. As a primary-care doctor who cares for the frail elderly and also someone who has studied and written about our health care system, I see no move by any political entity or hospital in Maryland to initiate sensible change in our bloated and inefficient health care delivery system.

We in primary care have very pragmatic solutions, but we always go unheard. Why? Because in any meaningful reform in which patients benefit and the system saves money, there will be two losers: specialist doctors and hospitals, and they are the ones who hold all the political clout. When I see my frail elderly patients whisked to hospitals because they have no other option, when I see their specialist doctors flood them with detrimental pills and expose them to a rash of dangerous (but profitable) tests and procedures, I don’t have to look very far to see why our health care system is failing.

While precise numbers are not available for Medicare, for Maryland’s CareFirst program 20 percent of total cost goes to hospitals and 27 percent does to specialist physicians. Primary care doctors account for 5 percent of CareFirst spending. And we know from ample literature that in areas of the country that are specialist-dominant and have a low primary-care presence, health outcomes are worse while costs escalate.

For Maryland to be successful in fixing the system, we have to rein in specialists and hospitals while incentivizing primary care. Since specialists and hospitals are leading the reform effort, it is very dubious that anything meaningful will occur.