Ford Vox is resident physician at Washington University School of Medicine’s neurology department.

– Ford Vox is a medical journalist and a physician. The opinions expressed are his own.–

A trade group by the name of America’s Health Insurance Plans began the week with oddly revealing rhetoric against a key proposal under debate at the health care summit today – controlling insurance premium hikes. Obama’s proposal “would be like capping the prices auto makers can charge consumers, but letting the steel, rubber, and technology manufacturers charge the auto makers whatever they want,” said Karen Ignagni, AHIP’s president.

Ignagni’s analogy shifted blame onto doctors and hospitals — the rubber and whatnot — but her analogy is apt in one way – we’ve got to pay attention to where the rubber hits the road. Relying on face-to-face relationships and earned trust, doctors are better poised to control costs than any federal agency or insurance company. Family practice doctors, who wield the referral, are the key to reigning in the excessive outpatient specialist care that accounts of much of the waste in American medicine. But they need some skin in the game.

University of Manchester researchers followed UK private practices and chronicled the power shifts that occurred after the roll out of the 2004 National Health Service contract, which was designed to allow family doctors to reap financial rewards by proving they’re keeping their populations healthy. U.S. legislation can similarly require that whatever fund is paying the bill (private, Medicaid or Medicare) hand over more control to the doctors on the front lines by designating more administrative responsibilities, and the dollars that go with them, to physician practices.

The National Committee for Quality Assurance has already laid some foundations, getting primary care physician organizations on board with the concept of the medical home, so that primary doctors will adopt outcome measures and accepted processes that are known markers of quality and that keep costs down.