The larger lesson of tonight's "Frontline" (10 p.m. WQED/WQEX) examination of the cruel, bottom-line realities of managed health care is subtle -- there's no such thing as a free quadruple bypass. Somebody somewhere has to pay for it.
That hardheaded fact of real life is not the primary message the producers of "Dr. Solomon's Dilemma" intended to deliver in their look at how a group of doctors in Boston are struggling to cut the high cost of medical care without cutting the quality of that care.
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When: 10 tonight on PBS (WQED/WQEX).
Producer: David Murdock.
But after hearing the good doctors explain how they feel about having to think and act like businessmen if their group of physicians is to survive in the new competitive environment, the painful economic truth that nothing in life is free ought to be evident.
Correspondent Hedrick Smith and producer David Murdock take viewers behind the scenes at Beth Israel Deaconess Medical Center, a world-renowned Harvard Medical School teaching hospital that is administered by a managed health- care company called CareGroup. The main focus is on the constant cost-care dilemma faced by doctors like Martin Solomon and the health care administrators who watch the (very red) bottom line. Dr. Solomon has joined with 10 other doctors in a mutual-review group called a "pod" that tracks each doctor's per-unit (i.e., patient) cost data like a pack of Price-Waterhouse CPAs.
The pod must balance its books at the end of the year -- no easy task -- and the doctors keep tabs on each others' costs. It's hardly the good old days of hand-holding doctors and 10-day maternity stays in hospitals.
Dr. Solomon, like most of the hospital patients, thinks this new cost-consciousness -- this way of seeing patients as money-losers and not sick people in need of care -- is ruining health care and destroying the trust between doctor and patient.
"Frontline" explains the financial nuts and bolts of managed care, introduces the non-hospital world to terms like "incentivized' and "globally capitated contracts" and explains why CareGroup cannot afford to lose $5 million a month forever.
But mostly we hear talk about money and medical morals from doctors who have patients like the 52-year-old man who must undergo a $30,000 bypass operation and a dying elderly man who racks up a $619,000 hospital bill for 67 days in intensive care.
"Dr. Solomon's Dilemma" is an informative biopsy of the great health-care malignancy. It doesn't pretend to look at the big picture, doesn't offer any grand solutions and doesn't explain how the economics of the health and medicine "marketplace" are skewed by government meddlings and the third-party payment system.
But the hour show is informative, well done and not out to trash doctors, hospitals or even insurance companies. It is further proof that any subject -- even the brain-stopping intricacies of managed health care -- can be humanized and made interesting by the clever producers of "Frontline."