Welcome to primary care in the USA:

To use the same fast food analogy, imagine a situation where price was no longer an issue (because of insurance) and the hungry masses started demanding the best burgers in the world . . . . but they wanted to wait no longer than they did for the regular “McDonaldized” burger. The problem is that the amount of money that the restaurant gets from the “burger insurance company” is little more than what they got from the customer when the meal was paid for directly. So the burger guys are stuck.

Unlike the gourmet burger place across the street that accepts only cash (or plastic), the “fast food” burger guys (who only take burger insurance) can’t increase their prices. If they could then they could serve fewer customers and concentrate on quality while trying to hold down wait times. What to do? There are only two choices. 1. Close up shop or 2. Serve the crappiest burgers as possible so that wait times can be as short as possible, cash flow is kept stable to maintain profitability and cover overhead, and hope that nobody notices.

Oh, but Dr. Rangel, you’re not suggesting that the quality of American health care is being kept low by the current physician reimbursement rates, are you? Oh yea. You bet your ass I am.

Until reimbursement is properly fixed, or at least delinked to quantity, this is only going to continue.