This works in theory, but in real life, not so much. Concierge medicine might work for routine doctor visits. For surgery or trauma or oncology treatments, not so much.

txmomof6 on November 15, 2012 at 3:43 PM

So how often do you need surgery, trauma care, or oncology (cancer) treatment? These kinds of usually “bad news” (non-trivial) situations are what insurance would normally be for not for routine checkups and such. In this particular case, your examples don’t invalidate an emphasis on a cash system with insurance as insurance. Also, if a person really wants EVERY possible (non-trivial) surgery they could undergo to be covered by their insurance they can pay for in their premium for that coverage but for those who are willing to make a reasonable tradeoff, they don’t have to.

If you try to superimpose the cash system enmass (or by fiat) over the entire range of health care then you’re right. There is a path dependency problem — you are here in the insurance covers everything big and small, how do you get to where insurance pretty much only covers big things and not small things.

A point could be made, especially when I note “reasonable tradeoff” that people can make mistakes that can turn out disasterously. That can happen, but can one say that imposing high premium costs over everyone (all covered people) to avoid that is acceptable? I think that we would not want the perfect or near perfect solution (in people’s minds) which has very high costs (which then everyone wants to try and reduce because it is so costly) to be the enemy of the good enough. There would certainly be an equilibrium point somewhere between the current setup and a cash/price oriented setup. The problem in the current setup is how to get there in a reasonable transition, if we do ever go there.

1. How many people sitting behind a CRT in a typical medical office (one that depends on insurance for every payment) are actually providing health care???

2. Can anyone tell me why it makes sense to use insurance to process a bill for a prescription which sells for $3-$15?? I haven’t seen actual studies of medical billing costs, but in the private sector, this kind of paperwork costs a minimum of $35 to process.

3. Why is government pressuring doctors and hospitals to use x-rays instead of modern tomography? Computer-assisted scans produce dramatically more useful results. And the cost of computer-assisted scan technology are coming down…and could come down much more rapidly if the government/insurance complex was not blocking the technology. Isn’t this a prime example of a foolish policy which sacrifices patient care and long term costs for the illusion of short-term savings??

4. How does the hiring of 1600+ IRS agents bring down the cost of health care?

Places like The Surgery Center are upsetting the government’s apple cart… The Surgery Center is providing a good service at a reasonable price… the government will find a reason to shut it down.

and have an economic model that would encourage family practice provider to emerge, especially since the costs are lower to get certified in that kind of medicine rather than surgery or other specialties.

The author of this article clearly does not know what he is talking about. So long as a primary care physicians’ pay is so low, someone who has already incurred medical school debt is not going to be attracted to it. On a pure economic basis, going into primary care makes little sense.

Trust me; the Obamacare juggernaut will make such common-sense businesses illegal.

The next step is a medical ship that sails out to international waters to do something radical; practice medicine absent massive bureaucracy.

michaelo on November 15, 2012 at 2:09 PM

Nah, it will happen on Indian Reservations much like the casinos operate now.

The best healthcare sysrtem in the world – unless you consider stuff like outcomes, infant mortality and longevity. You know, medical stuff.

plewis on November 15, 2012 at 2:33 PM

Perhaps, if you find health care in America so lacking, you should consider moving to a country with “wonderful” health care.

That “medical stuff” is not going to improve under obamacare. It will, in fact, get appreciably worse.

Why wait? Emigrate now and avoid the rush.

It simply won’t work if Medicaid exists. Then everyone would be one it so they wouldn’t have to pay.

Check out the Australian system which runs a parallel public/private system and uses tax incentives to encourage people who can afford private health insurance to purchase it, while supporting the poor with a public hospital system, ‘bulk billing’ by many GPs and Medicare. Heck, there’s even a ‘Medicare Private’. It works pretty well, even though our current socialist government would tinker with it.

http://www.paratisiusa.blogspot.com

God Bless America!

Free market medicine? For a quick idea check what the largest cause of bankruptcy declarations in America is. I won’t spoil the surprise but it might have something to do with the “best healthcare system on the planet”.

lester on November 15, 2012 at 1:56 PM

As mentioned above, one reason for this is classification of any bankruptcy where there is a balance of medical costs of about $1000 or more as a healthcare related bankruptcy, even if there was $20K in credit card debt.

In addition, most persons who do experience true health related bankruptcies do so despite having insurance, because of the 20% copay, which doesn’t max out and is based on the listed price, not the heavily discounted total that is billed to the insurer.

Also, the prices on the bill are very inflated for multiple reasons. a $2 aspirin would be cheap. It takes a lot of skill to negotiate the prices downward, and some facilities won’t even give a cash discount for self pay patients which is really unfair considering the discounts insurers get.

In the US, hospitals have to pay for administrators plus there are huge costs associated with all of the regulations that the hospitals must follow. Some are important and necessary. Others not so much. There are huge labor costs involved in the paperwork. Electronic records do little to reduce this burden. Electronic records are also very expensive. It costs $10,000′s per provider per year to maintain an electronic health record.

For instance, a transfer of a patient from an acute care hospital to a rehab facility might involve a 20 page form that the nurse must fill out. Thus, nurses can take care of fewer patients because they have so much paperwork to do.

Now that everything is done on computer, people working in hospitals become superspecialized, perhaps able to do one thing-monitor stress tests or draw blood or start an IV or collect the contaminated sharps containers or check patients in to the pre procedure unit, because they have to know how to use a computer program for everything they do. (It took 4 of us 20 minutes one day to figure out how to enter the order: daily PT/INR. call for coumadin dose-in many ways, paper was easier)

When you can’t cross train, your labor costs go up.

Unfortunately, word is that Rick Scott, Governor of Florida, is going wobbly about refusing to set up exchanges for ObamaCare. All you from Florida, please contact him and tell him to say NO!!!

http://www.flgov.com/contact-gov-scott/email-the-governor/

But it’s clear that Obamacare isn’t really about saving money. If it was, it wouldn’t include so many regulations, guidelines, oversight boards and reporting requirements. All of those things add to cost.

RMOccidental on November 15, 2012 at 3:39 PM

You sir – win the thread.

As for the doctor education argument… my wife is in the 3rd year of a 4 year residency for Family practice/Neuromuscular medicine. She’s planning on doing a sports medicine fellowship.

It will be 9 years since she started this process when she finally is able to start being compensated more than a barely-more-than-minimum-wage worker. Meanwhile we have been making payments on her medschool debt that, at the apex was nearly $300k.

I’d say if you want more doctors, make medical education cheaper. Loans aren’t the issue… its the fact that you’re basically living paycheck to paycheck for a decade of your life that turns a lot of people off of training to become a doctor.

It doesn’t matter how many slots there are if all of the students aim to go into a specialty because they get paid more. Who do you force to go into general medicine? The ones who are too stupid to cut it on the specialty track? That’s who I want as my primary care doctor!

Night Owl on November 15, 2012 at 4:12 PM

Well – matching up your argument with the ones I’ve posted – the easy answer is obviously – affirmative action. Qualifications and actual intelligence and capabilities don’t matter – just minority status – and viola – lots of new federal government approved doctors.
I think I’ll pass on the major surgery….

To be a doctor? You’ll have to be have a federal license.
Or you won’t be able to practice.

athenadelphi on November 15, 2012 at 4:03 PM

And you’ll be forced to accept whatever maximum wage the gubmint declares you are allowed to get.

So to bring this back around to this suggestion:

Double the number of medical schools.

kunegetikos on November 15, 2012 at 2:55 PM

How many people do you think will want to go into a field that requires many years of school, very hard coursework, huge expense, and killer residency hours – only to be told your lieftime earnings will be capped and controlled by the federal government?

I understand you. But isn’t this like the moonbat argument against energy? If we would just do it, in 8 years it would be DONE.

kunegetikos on November 15, 2012 at 4:03 PM

It doesn’t matter how many slots there are if all of the students aim to go into a specialty because they get paid more. Who do you force to go into general medicine? The ones who are too stupid to cut it on the specialty track? That’s who I want as my primary care doctor!

kunegetikos on November 15, 2012 at 2:57 PM

Good luck with that. Where will you find the doctors to teach at the medical schools or to staff the residency programs? Where will you get the patient load to justify the number of cases that are required to train a doctor adequately? And even if you could wave a magic wand and double the slots, it still takes a minimum of 8 years to get someone from graduation from college to practicing medicine in a general field of medicine so what do you do in the meantime?

txmomof6 on November 15, 2012 at 3:47 PM

Also, where will you get the med students qualified to fill those expanded med school slots?
Look at the stats on how many students graduate from college in what kind of majors. As a percentage of all college grads, biological sciences and chemistry (necessary for med school) are a small percentage. We have the same problem with engineering and other hard sciences – too many kids are going for the easy fuzzy studies degrees and not willing to work hard enough for the hard sciences – which means you won’t find enough qualified students to fill all those new med schools.

it still takes a minimum of 8 years to get someone from graduation from college to practicing medicine in a general field of medicine so what do you do in the meantime?

txmomof6 on November 15, 2012 at 3:47 PM

I understand you. But isn’t this like the moonbat argument against energy? If we would just do it, in 8 years it would be DONE.

2 tier medicine is not in the plan. ALL DOCTORS will participate in Obamacare. Good luck to those that have just opened their own surgical centers. Hope you got your tax write off because THAT is going away too.

It comes down to the same thing that got Obamacare as the law of the land: Commerce clause. The regulation of doctors will occur because one doctor who is in private practice in TX will have an impact on the doctors in a government program in NY.

Its true that the states are the ones that give the doctors their license to practice but Obamacare will make it a federal license that is needed, citing commerce clause – that the drugs used are cross border, the 10 panel judgment of life/death is the end result and all must bow down to that, so its not a state issue anymore.

To be a doctor? You’ll have to be have a federal license.
Or you won’t be able to practice.

Outcomes? Ask Liam Neeson. Canadian hospitals lack the necessary diagnostic equipment because of rationing. So his wife, Natasha, died:

Since you libs love anectodal evidence so much

Her body had to come to the US so they could figure out what happened to her.

PastorJon on November 15, 2012 at 3:10 PM

Sorry to say – this story is not a valid indictment of Canadian medicine (there are plenty of others though). In this case, she refused medical help for several hours because she felt fine. When the bad headache started, she finally went to see a doctor but by then it was too late. So this was just not a case of poor Canadian medicine.

BTW – Here in the US (Maine) my Dad had a stroke about 6 years ago – instant throbbing headache and loss of vision in both eyes. My Mom got him to the ER fast, and after awhile they gave him tylenol for his headache and told him to go see an opthamologist about his sudden loss of vision – and sent him home. The opthamologist diagnosed the stroke and sent him back to the ER. He survived the stroke with no major paralysis, but it was too late to save his eyesight.

I had the same concern for my son a year ago. He was attacked on the street in a college town 2 hours away from us – hit in the back of the head with a bicycle U-lock – but he didn’t tell us until the next morning when he still had concussion symptoms. I told him to go to the ER immediately, where he got a CT scan that luckily indicated no real damage (like Natasha had). BTW – the ER visit and CT scan cost over $2000 – glad we had decent medical insurance.

dentarthurdent on November 15, 2012 at 3:49 PM