Let us start from one clear understanding, yes, millions of Americans do not have health insurance, but that does not mean they do not have health care. Anyone who shows up at a public hospital with an illness or injury must be treated, regardless of health insurance. Many see doctors and pay as they go.

The problem with health care in the USA is that it is too expensive, even for the Government. We pay 2.4 times what it costs for health care in Spain, a country in which I have extensive knowledge of its health care, for health care on a par with that of Spain. This statistic holds more or less true for all Western European countries. All the various indicators of health care, e.g. longevity, infant motality, incidence of serious illness and such, are similar, but the cost is more than twice what we pay in the USA.

And why do we pay so much? Many point to the insurance companies as the cause. But insurance companies charge rates that allow them to pay costs, i.e. medical expenses for their clients, plus profit margins tightly controlled by state insurance regulators. Many point to excessive court awards of damages in medical malpractice suits. The reality here is that it is not so much the cost of the damage awards, but the expensive tests and procedures medical practioners use to defend themselves against law suits. Others point to drug makers and their excessive profits. But these are the guys who have to bear the costs of developing new drugs with no guarantees that they will get paid for these costs.

No, the real reason for outrageously excessive health care expenses in the USA lies with our doctors. The average pay for a medical doctor in the USA is over $250,000 a year, and that is the average. The next highest paid professionals are lawyers coming in at about $90,000. The reason the Spaniards get the same level of health care we get, at 40% of the cost, is because their doctors make substantially less than ours. Drug costs, hospital charges, insurance rates, an so on are essentially the same. The only difference between costs in the USA and costs in Spain, or any other Western European country for that matter, is the cost of our doctors. In my old age I have finally come to understand why our surgeons wear masks and carry dangerous weapons.

President Obama is right when he points to the high cost of health care in the USA as the problem. However, nothing in his proposal for change touches on the subject of the excessive fees charged by our doctors. The only reign on this is the rules for Medicare and Medicaid payments where the Feds set maximum fees they will pay. But they do not set payments for all treatments.

Given the power of the doctors and their guild the AMA I do not see Obama or any other politician taking them on directly. So we are resigned to suffering excessive doctor fees. Or are we?

There is one bright spot in the equation that I believe will eventually solve the mess. We now have many physician assistants or “P.A.s” as our primary care “doctors.” They do almost all that doctors can do, but with a big difference, their average pay is about one-third or less than that for doctors. If we can cut the cost of primary doctor care by over two-thirds we can make significant savings in our health care costs. And I believe this is what will eventually happen as the insurance companies and the Government have to cut rapidly excalating medical costs.