4/20/2009 8:45:50 PM

Per the Congressional Budget Office:

Quote :

"Other approaches—such as the wider adoption of health information technology or greater use of preventive medical care—could improve people’s health but would probably generate either modest reductions in the overall costs of health care or increases in such spending within a 10-year budgetary time frame."

http://www.cbo.gov/ftpdocs/99xx/doc9924/12-18-KeyIssues.pdf

4/20/2009 8:52:51 PM

Quote :

"maybe because the out of pocket costs are keeping people from having coverage?"

Maybe if gov't hadn't caused the costs to get so asininely out of hand in the first place, then we might not have a problem?

Quote :

"so what do you propose we do with the millions who have no coverage? hope the market sorts it out?"

Well, first we be honest about it and quit inflating the number with illegals, people who won't buy insurance, and people who don't need insurance.

Quote :

"Pink you seem to be stuck in this idea that your insurance provider should pay for everything. Thats really whats gotten us into this mess."

bingo.

4/21/2009 6:50:41 AM

Quote :

"With respect to choices in private vs. government insurance plans, I simply cannot fathom how the government is going to maintain competition when it enters the market offering plans that are subsidized and thus unfairly priced below the market. Sure, we will have the same number of choices when it is implemented, but over time private companies won't' be able to compete with the government's subsidized plans, which will eventually crowd out most private firms. This will ultimately leave us with the government as the primary provider for most Americans and a few private plans for the wealthy. "

Well said. THis was the point I was trying to make earlier but you articulated it much better than I ever could have. I think most people being honest with themselves can see this happening. Look no further than medicare for a clear example, and why private ins. rape people with rates right before they lose them forever when they hit 65.

4/21/2009 9:28:55 AM

Quote :

"Donald J. Boudreaux's Economics in Many Lessons: Health care's simple economics One of the cherished beliefs of many Americans today is that health care can be improved only through a collective effort. As a television talking head expressed it recently, "We all have to pull together to improve health care in this country." Nonsense. Each of us has it within our power to improve our own health care. I can improve my and my family's health care in numerous ways, all of which are within my power. I can prepare more healthful meals; do more exercise; drink less alcohol; go to bed earlier. I can also, say, drive a less-expensive car or buy fewer consumer electronics and, with the money I save, purchase more exercise equipment, better health insurance or more visits to my doctor. What's true for me is true for every American. Even the poorest American is far from living at a subsistence level. That person, too, has the individual power to improve his or her health care by doing many of the sorts of things that I can do. Of course, no one, not even Bill Gates, can achieve "perfect" health -- if by that is meant 100 percent assurance of being free from aches, pains and the risk of dying before, say, the age of 80. And it's true that the wealthier an individual is, the greater is that person's scope to improve his or her health care. But it's not true that health-care improvements require a collective effort. In fact, steps taken to collectivize health-care provision have only made it more difficult for individuals to improve their own health care. Collective efforts -- which, in practice, mean "imposed by government command" -- typically allow each of us to free-ride off of each other's resources. And when I get to spend your money and you get to spend mine, it's a sure bet that that money will be spent wastefully. Consider Medicaid and Medicare -- huge socialized health-care programs. Funded with tax dollars, these programs allow the millions of Americans covered by them to consume medical services without paying the full cost of those services. The predictable result is that these services are over-consumed. To see why, ask the following question posed by my George Mason University colleague Russell Roberts. If you go to dinner with a large group of strangers and you know that the bill will be split evenly, aren't you more likely to order pricier dishes and drinks than you would order if you, and you alone, were responsible for picking up your full tab? The answer is surely "yes." Let's say that you'd be content to order the pork chop priced at $15, but would get even greater enjoyment from ordering the rack of lamb priced at $25. If you alone were responsible for your tab, you'd order the lamb only if it is worth to you at least the extra $10 that it costs. So suppose that you value the lamb by only $8 more than you value the pork chop. In that case, you'd order the pork chop. You wouldn't spend an extra $10 to get extra satisfaction worth only $8. But if the bill is evenly shared among, say, 10 diners (yourself and nine others), then if you order the lamb, your share of the higher bill will be only $1. That's $10 split evenly 10 ways. You'll order the lamb. You might think that this sharing arrangement is good. After all, in this example, the cost to you of getting something you valued more (the lamb rather than the pork chop) was reduced. It became sensible for you to order the lamb. Look more deeply, though. What happened is that society (here, the 10 diners) was led to supply something that wasn't worth its cost. The lamb was worth to you only an additional $8, but to make it available to you, society spent $10. Ten dollars were used to raise the welfare of society by only $8. (You're a member of society, so any improvement in your welfare counts as an improvement in the welfare of society.) That's a waste of $2. You are better off, but the group is worse off. Now look even more deeply. Everyone at the table faces the same incentives that you face. You're not the only person who will order excessively costly dishes and drinks. Everyone will. The entire table over-consumes. The total bill is higher -- even your share is higher -- than it would have been had the bill not been split evenly. Resources are wasted. Such sharing of our medical-care bill takes place now on a massive scale. It is impossible to see how expanding this sharing will reduce the bill."

http://www.pittsburghlive.com/x/pittsburghtrib/s_622894.html

4/30/2009 9:50:49 AM

How is it that people trust the government to torture, wire tap, imprison people indefinitely, and bomb other countries; yet, they don't trust the government to provide health care?

5/3/2009 4:45:12 PM

Well, lets look at it this way. Torture, wiretaps, imprisonment and bombing are (in order from least to most) authorized activities of the government as set forth in the constitution. These things are one of the jobs assigned to the government. Now, in each of these, has the government (and the people) successfully kept the powers in check, to be used only when absolutely necessary? Have they kept these activities to a nominal cost? Have they engaged in these activities in a way which best benefits the country as a whole and not special interests and the politicians? Would you call the government's endeavor in any of these areas in the last 50 years to be a successful, legal, constitutional, legitimate, healthy and worthwhile campaign to improve the nation, and otherwise justify the expenditures that went with them? If not then why in the world do you think that having the government act as an HMO will provide any different results?

5/3/2009 5:21:16 PM

Quote :

"How is it that people trust the government to torture, wire tap, imprison people indefinitely, and bomb other countries; yet, they don't trust the government to provide health care?"

I don't trust the government with any of those; in particular, it's been shown that they're prone to rampant abuse. A perfect case against letting the very same government get its grubby mitts on healthcare.

5/3/2009 5:41:49 PM

^^
How is wire tapping and indefinite imprisonment authorized by the Constitution?

5/3/2009 6:07:33 PM

One could argue that those things would fall under ensuring domestic tranquility, providing for the common defense and even general welfare, in much the same way that proponents of government healthcare systems say that falls under the general welfare part. But then there's also these parts to cover imprisonment:

To define and punish piracies and felonies committed on the high seas, and offenses against the law of nations;

To declare war, grant letters of marque and reprisal, and make rules concerning captures on land and water;

And lets not forget every one's favorite interstate commerce clause and the necessary and proper clauses.

I don't particularly think these are authorized by the constitution any more than I think healthcare is, but if you accept for the sake of argument the government healthcare is constitutional, then clearly these other things have similar backing.

5/3/2009 6:47:59 PM

Quote :

"Would you call the government's endeavor in [torture, wiretaps, imprisonment and bombing] in the last 50 years to be a successful, legal, constitutional, legitimate, healthy and worthwhile campaign to improve the nation, and otherwise justify the expenditures that went with them? If not then why in the world do you think that having the government act as an HMO will provide any different results?"

I agree with your argument that, given our track record, adding yet another program to our bloated system is worrisome. However, I can't relate to your last question regarding different results.

When the government bombs another country, I expect thousands of people to die. When the government provides health care, I expect that thousands of people will potentially survive.

My argument was merely that, given the distrust that people generally have for the government, why do some trust it to properly kill people, but not to properly heal people?

Quote :

"Torture, wiretaps, imprisonment and bombing are (in order from least to most) authorized activities of the government as set forth in the constitution."

Quote :

"I don't particularly think these are authorized by the constitution any more than I think healthcare is, but if you accept for the sake of argument the government healthcare is constitutional, then clearly these other things have similar backing."

Devil's advocate?

I'll agree that none are constitutional, but I would wager that we would both agree on some government programs that are both unconstitutional and very necessary.

[Edited on May 4, 2009 at 2:28 AM. Reason : ]

5/4/2009 2:26:31 AM

Quote :

"why do some trust it to properly kill people, but not to properly heal people?"

The government's track record in both activities should have anyone question how much we want the government assuming responsibility for supplying our goods/services. The Vietnam and Iraq wars alone are enough proof to suggest we should question government officials' judgments. Regarding their ability to "heal people," the lack of a successful record running services (Medicare, Social Security, DMV, ect) should be additional reason to be wary.

5/4/2009 6:48:48 AM

Quote :

"My argument was merely that, given the distrust that people generally have for the government, why do some trust it to properly kill people, but not to properly heal people? "

Because killing other living creatures is something we've been doing since the dawn of time. It's easy, it's simple and if you don't care about who in particular you kill, given the tools of today, Teri Schiavo could have killed millions. Also, killing is easily generalized across the board, it doesn't take a specialist to kill someone.

By contrast, healing people, and in particular healthcare is a specific individualized procedure that involves 1 on 1 interaction at some level and requires delicate and constant care. And if there's one thing that government fails at, it's delicacy.

Also, if you want to look at it from a philosophical point of view, health care is an individual choice. Killing should never be except in the most extreme circumstances. So we leave systematic killing to an authority which in theory makes its decisions based on the choices of many, in the hopes that the many will temper the few and reduce the number and frequency of killings.

Quote :

"Devil's advocate? I'll agree that none are constitutional, but I would wager that we would both agree on some government programs that are both unconstitutional and very necessary. "

Not devils advocate, simply ignoring strict constitutionality for the sake of the argument. If I wanted to argue from my personal beliefs on the constitution, the question over trust in the government would be irrelevant because it's already unconstitutional and no further discussion is needed.

As for unconstitutional and very necessary, no if it isn't constitutional, it isn't necessary. Nice, useful, even potentially should be within the domain of the federal government, sure, but necessary no. If it were necessary, we would have seen a 3/4 state vote for an amendment to make it constitutional.

5/4/2009 7:57:39 AM

Quote :

"Dr. Gottlieb, a former official at the Centers for Medicare and Medicaid Services, is a fellow at the American Enterprise Institute and a practicing internist. He's partner to a firm that invests in health-care companies. At the heart of President Barack Obama's health-care plan is an insurance program funded by taxpayers, administered by Washington, and open to everyone. Modeled on Medicare, this "public option" will soon become the single dominant health plan, which is its political purpose. It will restructure the practice of medicine in the process. Republicans and Democrats agree that the government's Medicare scheme for compensating doctors is deeply flawed. Yet Mr. Obama's plan for a centrally managed government insurance program exacerbates Medicare's problems by redistributing even more income away from lower-paid primary care providers and misaligning doctors' financial incentives. Like Medicare, the "public option" will control spending by using its purchasing clout and political leverage to dictate low prices to doctors. (Medicare pays doctors 20% to 30% less than private plans, on average.) While the public option is meant for the uninsured, employers will realize it's easier -- and cheaper -- to move employees into the government plan than continue workplace coverage. The Lewin Group, a health-care policy research and consulting firm, estimates that enrollment in the public option will reach 131 million people if it's open to everyone and pays Medicare rates, as many expect. Fully two-thirds of the privately insured will move out of or lose coverage. As patients shift to a lower-paying government plan, doctors' incomes will decline by as much as 15% to 20% depending on their specialty. Physician income declines will be accompanied by regulations that will make practicing medicine more costly, creating a double whammy of lower revenue and higher practice costs, especially for primary-care doctors who generally operate busy practices and work on thinner margins. For example, doctors will face expenses to deploy pricey electronic prescribing tools and computerized health records that are mandated under the Obama plan. For most doctors these capital costs won't be fully covered by the subsidies provided by the plan. Government insurance programs also shift compliance costs directly onto doctors by encumbering them with rules requiring expensive staffing and documentation. It's a way for government health programs like Medicare to control charges. The rules are backed up with threats of arbitrary probes targeting documentation infractions. There will also be disproportionate fines, giving doctors and hospitals reason to overspend on their back offices to avoid reprisals. The 60% of doctors who are self-employed will be hardest hit. That includes specialists, such as dermatologists and surgeons, who see a lot of private patients. But it also includes tens of thousands of primary-care doctors, the very physicians the Obama administration says need the most help. Doctors will consolidate into larger practices to spread overhead costs, and they'll cram more patients into tight schedules to make up in volume what's lost in margin. Visits will be shortened and new appointments harder to secure. It already takes on average 18 days to get an initial appointment with an internist, according to the American Medical Association, and as many as 30 days for specialists like obstetricians and neurologists. Right or wrong, more doctors will close their practices to new patients, especially patients carrying lower paying insurance such as Medicaid. Some doctors will opt out of the system entirely, going "cash only." If too many doctors take this route the government could step in -- as in Canada, for example -- to effectively outlaw private-only medical practice. These changes are superimposed on a payment system where compensation often bears no connection to clinical outcomes. Medicare provides all the wrong incentives. Its charge-based system pays doctors more for delivering more care, meaning incomes rise as medical problems persist and decline when illness resolves. So how should we reform our broken health-care system? Rather than redistribute physician income as a way to subsidize an expansion of government control, Mr. Obama should fix the payment system to align incentives with improved care. After years of working on this problem, Medicare has only a few token demonstration programs to show for its efforts. Medicare's failure underscores why an inherently local undertaking like a medical practice is badly managed by a remote and political bureaucracy. But while Medicare has stumbled with these efforts, private health plans have made notable progress on similar payment reforms. Private plans are more likely to lead payment reform efforts because they have more motivation than Medicare to use pay as a way to achieve better outcomes. Private plans already pay doctors more than Medicare because they compete to attract higher quality providers into their networks. This gives them every incentive, as well as added leverage, to reward good clinicians while penalizing or excluding bad ones. A recent report by PriceWaterhouse Coopers that examined 10 of the nation's largest commercial health plans found that eight had implemented performance-based pay measures for doctors. All 10 plans are expanding efforts to monitor quality improvement at the provider level. Among the promising examples of private innovation in health-care delivery: In Pennsylvania, the Geisinger Clinic's "warranty" program, where providers take financial responsibility for the entire episode of care; or the experience of the Blue Cross Blue Shield plans in Pennsylvania, Michigan and Virginia, where doctors are paid more for delivering better outcomes. There are plenty of alternatives to Mr. Obama's plan that expand coverage to the uninsured, give them the chance to buy private coverage like Congress enjoys, and limit government management over what are inherently personal transactions between doctors and patients. Rep. Nydia Velazquez (D., N.Y.) has introduced a bipartisan measure, the Small Business Cooperative for Healthcare Options to Improve Coverage for Employees (Choice) Act of 2009, that would make it cheaper and easier for small employers to offer health insurance. Mr. Obama would also get bipartisan compromise on premium support for people priced out of insurance to give them a wider range of choices. This could be modeled after the Medicare drug benefit, which relies on competition between private plans to increase choices and hold down costs. It could be funded, in part, through tax credits targeted to lower-income Americans. There are also measures available that could fix structural flaws in our delivery system and make coverage more affordable without top-down controls set in Washington. The surest way to intensify flaws in the delivery of health care is to extend a Medicare-like "public option" into more corners of the private market. More government control of doctors and their reimbursement schemes will only create more problems."

http://online.wsj.com/article/SB124208383695408513.html

[Edited on May 13, 2009 at 4:10 PM. Reason : /]

5/13/2009 4:06:41 PM

hey look, an editorial from foxnewspaper

5/13/2009 4:18:37 PM

haha, written by a DOCTOR. No, lets trust the community organizer's opinion first. Im sure he has read a book on it and all. Considering he is also a constitutional lawyer who took and oath to uphold the constitution and then acts like its written in arabic...err bad example... spanish. Ill take the doctors opinion over the big O.

5/13/2009 8:34:18 PM

^ hahahaha so how are your campaign talking points saved, is there a list somewhere?

5/13/2009 8:54:10 PM

and, surprise, surprise - the fine Doctor's main point of contention is that, wait for it, Doctor's may be paid less!

5/13/2009 9:07:54 PM

I bet if we pay less for something we'll get more of it. Isn't that how economics works?

5/13/2009 9:19:08 PM

^^ Yes, and this is a serious problem.

5/13/2009 9:25:29 PM

Single payor system uses the walmart model. Get as many suppliers as you can and force them to lower their prices cause you're the only game in town. The result? Everyone can afford your cheap crap.

5/13/2009 9:25:42 PM

his concern isn't solely that "OMG DOCTORS WON'T MAKE AS MUCH MONEY!!! NOW THEY CAN'T GET THAT EXTRA YACHT!!!" His point is that doctors won't be able to make enough money for their practice to even be profitable. Thus, said doctors will disappear, exacerbating the problem Obama is allegedly trying to fix: the difficulty people have in getting healthcare.

5/13/2009 9:26:25 PM

We are already facing a doctor shortage in the US, mainly from the inability to control your income anymore and the high cost of eduction.

http://www.cleveland.com/nation/index.ssf/2009/04/obama_administration_concerned.html

"WASHINGTON -- Obama administration officials, alarmed at doctor shortages, are looking for ways to increase the number of physicians to meet the needs of an aging population and millions of uninsured people who would gain coverage under legislation championed by the president.

The officials said they were particularly concerned about shortages of primary-care providers who are the main source of health care for most Americans. "

I think I read that med school applications and quality of applicants are down signifcantly over the last several years. And those in med school only 5% plan on going primary care. Contrast that with applications to Vet and Dental school which are up close to 40%.

5/13/2009 9:48:45 PM

"Some doctors will opt out of the system entirely, going "cash only." If too many doctors take this route the government could step in -- as in Canada, for example -- to effectively outlaw private-only medical practice."

This is one opportunity Im looking at taking advantage of. I would move to open up a cash only practice in a very populated area with average to above average income. Of course the big risk is after investing all the money to start up, some asshole comes in and just passes a law telling me that working and running my own business is now ILLEGAL.

5/13/2009 10:09:46 PM

^^^ There is another much easier problem to fix, the fact that we have fewer medical schools and fewer medical school graduates today than we did 100 years ago:

Quote :

"the marketplace doesn't determine how many doctors the nation has, as it does for engineers, pilots and other professions. The number of doctors is a political decision, heavily influenced by doctors themselves."

http://www.usatoday.com/news/health/2005-03-02-doctor-shortage_x.htm

Smash the AMA cartel and as doctors salaries fall, so will the price of healthcare.

[Edited on May 13, 2009 at 11:50 PM. Reason : .,.]

5/13/2009 11:48:40 PM

And it's sad to think so many believe the problems we have today are a result of a "free market" and our only solution is government coercion.

5/14/2009 9:50:14 AM

^

5/14/2009 9:54:37 AM

Quote :

"And it's sad to think so many believe the problems we have today are a result of a "free market" and our only solution is government coercion. "

I agree

5/14/2009 9:56:02 AM

Quote :

"Smash the AMA cartel and as doctors salaries fall, so will the price of healthcare. "

did LoneSnark
really advocated gov't intervention into free market pricing cause by an industry cartel?

5/14/2009 12:09:42 PM

of course - Conservatives are all about some government intervention when it comes to busing up industry groups. Union busting, anyone?

5/14/2009 12:20:23 PM

Quote :

"really advocated gov't intervention into free market pricing cause by an industry cartel?"

How exactly is ending a government-sanctioned monopoly - particularly with regard to institutional licensing - a government intervention into the free market?

Maybe in bizaro-world.

Don't laugh too hard at your own cleverness there, HUR and agentlion.

5/14/2009 12:22:36 PM

Hmmmm...yes, smash anything that tries to enforce industry standards. If someone ends up going to Dr. Nick and gets medical instruments left inside them or loses a kidney during a gallbladder removal, then it's their fault for not being a rational enough actor. We must preserve the truly free market.

5/14/2009 12:50:49 PM

So it's clearly unpossible that institutions like the AMA work to artificially restrict the supply of doctors. It must be solely out of a selfless obligation that they act.

Hey, I've got a bridge you might be interested in.

5/14/2009 12:56:38 PM

So the answer to that is to destroy the whole enactment of industry standards?

"Well, something bad happened, throw the whole thing out"

5/14/2009 12:58:54 PM

Yes, that's obviously the solution. Not examining whether the AMA has artificially restricted the accreditation of programs and number of slots for qualified students, but burning down the entire system.

Exactly.

5/14/2009 1:00:43 PM

Pardon me for thinking that you weren't proposing AMA reform. You're angry internet libertarian persona had me stereotyping you're response. Sorry, broski.

5/14/2009 1:04:27 PM

I'm just saying that the notion that the AMA has in effect acted as a cartel and artificially worked to limit supply - with the explicit sanction of the government - should not be overlooked.

I think if you examined it on the balance, there's plenty of bright, eager people out there that would make good doctors competing for too few slots. The result is shortage. It doesn't require scrapping the entire idea of certifying medical programs to recognize this.

5/14/2009 1:06:49 PM

DrSteveChaos for the win.

5/14/2009 2:30:54 PM

It is perverse to grant the force of law to a body elected and paid for by those it is supposed to regulate, which is what we have done with the AMA. As I understand it, the solution is quite simple: since the AMA has been granted the power of law by the legislature then it should also be staffed by the lagislature as well. As such, state government should revoke the AMA's role in physician board certification and instead create a state-run and regulated medical entity to assume such roles (staffed by doctors as the legislature chooses). This way, instead of the regulatory licensing body answering only to those it is licensing, it will now answer to the average voter, which cares more about safe effective treatment than the average doctor which cares more about restricting competition.

5/14/2009 2:56:37 PM

http://www.nbme.org/

5/14/2009 3:32:57 PM

http://www.optometry.org/ These are the national boards we had to take. 3 parts and the TMOD. Although you dont take them all the same year. In case you were interested.

After this you have to pass your state boards. Some are easy and just a test on that states laws, others are very difficult and are a whole day exam consisting of patient exams and different clinical testing stations, where you sit in an empty room with a very small desk in the middle while a table across the room with 4-6 doctors give you cases and drill you. It sucks to go through, but you feel great when you pass.

After that, you just have to file/pay to get your UPIN and DEA numbers. Then you have to file with each individual ins. compnay you plan on seeing. fun fun

5/14/2009 3:53:57 PM

This should be the model for reform...

http://www.youtube.com/watch?v=xQsbdAezt_Q

[Edited on May 14, 2009 at 9:26 PM. Reason : ,]

5/14/2009 9:26:17 PM

I love HSAs. It would lower costs overnight for primary care, plus cover you for the big stuff. Also allowing ERs to turn people away based on diagnosis and allowing practices/doctors to take a tax deduction for the indigent care for the full amount they charge instead of taking medicaid.. just do away with it completely.

5/15/2009 9:30:53 PM

I don't know a ton about HSAs other than you set pre-tax money aside to spend out of. How would this lower costs? And where is the profit being made such that the HSA has to be set aside ahead of time rather than just making certain health procedures tax deductible?

5/15/2009 9:44:44 PM

Quote :

"plus cover you for the big stuff."

uhhh.... how, exactly? It's still your money, even if you are saving 30 or 40% on taxes.

5/15/2009 9:48:14 PM

Quote :

"I don't know a ton about HSAs other than you set pre-tax money aside to spend out of. How would this lower costs? And where is the profit being made such that the HSA has to be set aside ahead of time rather than just making certain health procedures tax deductible?"

An HSA works off of the notion of a set-aside for rudimentary health expenses under a fixed amount with catastrophic coverage - typically a very high deductible, like say, $5000. Hence, one pays cash from a tax-deferred account for doctor's visits and low-cost care, removing the health insurance from the equation entirely, and thus lowering costs.

This has several structural advantages, including eliminating the first-dollar problem of current care (i.e., deductibles and co-pays), and thus incentivizing preventive care. The optimal HSA also allows for one to roll surplus funds from year to year, to build up a larger savings for both health emergencies and retirement.

The main opposition to this has been in the objection of this potentially acting as a tax shelter for the wealthy, rather than the structural efficacy of such an approach.

5/15/2009 10:27:54 PM

Quote :

"How would this lower costs?"

Because suddenly, when people have to personally shoulder the burden of their own primary care, they will begin to question the prices. They will ask questions like: Why can I get surgery performed on both of my eyes for $3,000 total, but a 15 minute visit + EKG with a doctor at the emergency room for stomach pains is close to the same price? Why can I take my dog for an exam when she's sick for $50, but I have to pay 3 times that?

When you get people involved in the price of their healthcare, they will start demanding lower costs. Instead, they demand lower cost insurance and the insurance companies demand lower costs of healthcare. This is an extremely inefficient way of lowering costs.

5/15/2009 11:13:38 PM

http://www.businessweek.com/magazine/content/07_28/b4042070.htm
http://www.boston.com/news/globe/editorial_opinion/oped/articles/2007/08/11/frances_model_healthcare_system/

Quote :

"An understanding of how France came to its healthcare system would be instructive in any renewed debate in the United States. That's because the French share Americans' distaste for restrictions on patient choice and they insist on autonomous private practitioners rather than a British-style national health service, which the French dismiss as "socialized medicine.""

Quote :

"Their freedoms of diagnosis and therapy are protected in ways that would make their managed-care-controlled US counterparts envious. However, the average American physician earns more than five times the average US wage while the average French physician makes only about two times the average earnings of his or her compatriots. But the lower income of French physicians is allayed by two factors. Practice liability is greatly diminished by a tort-averse legal system, and medical schools, although extremely competitive to enter, are tuition-free. Thus, French physicians enter their careers with little if any debt and pay much lower malpractice insurance premiums."

Quote :

"Nor do France's doctors face the high nonmedical personnel payroll expenses that burden American physicians. Sécurité Sociale has created a standardized and speedy system for physician billing and patient reimbursement using electronic funds. It's not uncommon to visit a French medical office and see no nonmedical personnel. What a concept. No back office army of billing specialists who do daily battle with insurers' arcane and constantly changing rules of payment."

Bottom line is they live longer than us and eat better food than us.

[Edited on May 16, 2009 at 3:00 AM. Reason : .]

5/16/2009 2:53:23 AM

agentlion and fail boat, drsteve and 1337 have answered both of your questions better than I could have.

I personally like the idea of competing for dollars. It would make our office run better as we our office and patients will be more focused on actual care issues than insurance issues which tend to be the majority of issues/questions in our office.

The ONLY problem I see with moving towards an HSA system is liability for the docs. If a patient declines a test which would have diagnosed the problem we have to make sure they can later not sue claiming, "he is the doctor, he should have made me take it... or I didnt know it was that important." Which will no doubt happen.

5/16/2009 8:21:27 AM

you were concerned earlier about Dr's pay going down under a single-payer system, but now that is being touted as a benefit of an HSA?

5/16/2009 9:41:32 AM