There are many reasons to be dismayed by the error-filled and managerially incompetent rollout of the federal health insurance exchanges that are in many ways the linchpin of President Obama’s Affordable Care Act. I sympathize with commentators who have called for the resignation of Department of Health and Human Services Secretary Kathleen Sebelius. It’s hard to imagine Franklin Roosevelt not firing someone in his cabinet had social security stumbled this badly out of the gate, or Lyndon Johnson not causing officials’ heads to roll if the launch of Medicare and Medicaid had been so mangled.
Still, I believe that throwing the baby (the ACA) out with the bathwater (government officials) would be a huge mistake. Healthcare costs will continue to rise with or without the law’s implementation, consuming an ever greater chunk of the struggling U.S. economy and causing government budgets to run into the red regardless of any future grand bargains on taxes and spending. The status quo stinks, and doing nothing is not an option.
Some of my physician colleagues have argued that the major problem in medicine today is that restrictive insurance companies and armies of utilization reviewers have curtailed our independence. Return decision-making power to doctors, they argue, and the system will run more efficiently. When surveyed recently about who had “major responsibility” to control healthcare costs , U.S. doctors called out trial lawyers, insurance companies, hospitals, drug and device manufacturers, and patients. Only one in three pointed the finger at themselves.
In an editorial  in the New England Journal of Medicine, family physician Cheryl Bettigole takes the opposite point of view. Noting how a $20 to $30 Pap smear can be transformed into a battery of tests (some unnecessary) that cost hundreds or even a thousand dollars, she argues that physicians have the primary responsibility for protecting patients from financial harm and being good stewards of health care resources:
The U.S. healthcare non-system provides physicians with numerous incentives to “do the wrong thing” in patient care. The more services we provide, the more money we make...