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Guest Post from Deborah L. Benzil, MD, FACS, FAANS
Member, AANS Board of Directors
Chair, AANS/CNS Communications and Public Relations Committee

Mt Kisco, New York

debThere is not much about healthcare policy on which everyone agrees; however one irrefutable fact acknowledged by most is that U.S. healthcare costs are rising, outstripping inflation, and thus exerting pressure on many aspects of the economy. In 2012, healthcare costs topped $2.8 trillion – and this trend shows no end in sight! Not only do these costs act as a drag on our economy, but Americans feel the pain directly, since over the last decade insurance premiums for the average family of four have risen more than 100 percent.

Beyond this basic fact, however, a fierce debate rages. Much of the recent focus on containing healthcare costs seems directed primarily at physicians. The debacle for holding down physician expenditures, known as the Medicare “sustainable growth rate,” is just one component of this process. (Little mentioned, and entirely forgotten, is the fact that the SGR was the only cost containment process left in place from the , while others that impacted other healthcare providers, including hospitals and nursing homes, were lobbied away). Physician services represent roughly 20 percent of each healthcare dollar, compared with more than 30 percent for hospital costs. Of the 20 percent for physicians, only a portion becomes actual physician take-home pay, as most of this goes towards practice overhead, which is high (and rising).

National Health Expenditures 2014 (projected) (2)

Elizabeth Rosenthal, in her excellent and insightful news analysis, “Medicine’s Top Earners Are Not the M.D.’s” discusses another closely held secret within our current healthcare system: the exorbitantly high administrative costs (in hospitals, health insurance, and healthcare systems) presently being paid. The article notes that Mark T. Bertolini, thecroppedRosenthal_400x400 chief executive of Aetna, earned a salary just under $1 million, but his total annual compensation was in excess of $35 million! Based on data from the , he earned more than 160 primary care physicians and 90 specialists combined! And he is just one executive of one insurance carrier.

So returning to what we all agree on — healthcare costs are rising too quickly. However, curtailing those costs should not break the back of those (the physicians) that provide the critical diagnostic and therapeutic interventions that help patients. Neurosurgeons provide accessible, compassionate care for patients with some of the most devastating medical conditions. We are there for our patients. We will work with those voices of reason to help ensure value in healthcare delivery and appropriate costs. But let us be RIGHT ON THE MONEY by understanding:

  1. Physicians were the only sector of healthcare whose costs were essentially capped by the Balanced Budget Act of 1997.
  2. Physician services represent a small fraction (less than 20 percent) of all healthcare dollars, the slowest growing component of healthcare costs.
  3. Administrators salaries are today’s TOP EARNERS in medicine, while providing no direct healthcare services and little or no direct benefits to patients.

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