We have been subjected to exposure of all the horrible things that happen in countries that have governmental or socialized medical care. Canada, England as well as most European countries are held up as examples of what type of care governments provide. I believe that medical care in this country not only causes bankruptcy and severe monetary strain on a considerable number of people but is often of less than desirable quality. The horror stories that one hears about from other countries are often not really as bad as some would like you to believe. The waiting times portrayed are quite often matched by the waiting times many of our patients experience. Getting in to see a primary care physician is quite long in many parts of the United States and the subsequent wait for the specialist and any scheduling of needed surgery can be protracted. The quality which we were so proud of has also suffered in the wake of managed care, HMO’s and the shortened office visits which have become the norm. The requirements of Health Insurance companies, Medicare, HMO’s and so on have made paperwork more important than patient care, especially if the physician wants to earn a living. The physician has to provide enough paperwork to justify his management of the patient but this is also important if he wishes to get paid. Satisfying the patient is of secondary importance.
There are many things in our medical system that are less than optimal. Health care needs improvement in more ways than one and one of these days it would be ideal if physicians could work to satisfy the patient instead of their insurance company.
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I would argue that the principle of all the arguments for or against universilized care are misaligned in priciple. First off, I can't see how a single payer system would work any better with regards to paperwork or to "satisfy" insurance companies....IRS, DMV come to mind. The US would in effect become the sole provider of insurance (forgetting for a second that they already provide a greater ratio via medicaid / medicare and have just as much paperwork). The system is alreay bankrupt and it is not just because of rising healthcare costs. Secondly, and I am open to other opinions, but I see the problem as not just PRIVATE vs. PUBLIC but is at least in large part the result of a third party payment system in general. Insurance, by definition, is the transferance of risk. Instead of a system where insurance covers the risk of catestrophic events, such as ER visits or surgeries, we allow them, no, WANT them to cover every sniffle and scratch. The result is that people dont spend their own money. And noone spends someone elses money as efficiently as the individual would spend it himself. It was great for physicians for a while because they didn't have to negotiate with their patients for fees but now docs have to "charge" outrageous amounts in hopes of collecting 40%. I would argue that the best offence is to put patients BACK in the driver seat and let them negotiate with you what they can best afford for your services... Would you really turn someone away who was willing and able to give you $20 for a 15 minute checkup? This would create more dialogue between you and your patient and ultimately improve patient satisfaction and 'quality' of the patient's experience...Again, people don't sue those they perceive as their friends.
A simple tax deductible HSA (with possible tie ins to a low risk mutual fund) with catestrophic insurance would make good incentive for younger people (and others) to invest in health insurance (they make up about 25-30% of the currently uninsured). Making a HSA portable would also reduce the incidence of lost insurance due to job loss (the ability to take it with you, like an IRA with employer matching)--incidentilly another 10-15% of the uninsured. I know I am speaking in generalities and there are many more factors that I am not considering but it is at least makes my point.
I would argue that the principle of all the arguments for or against universilized care are misaligned in priciple. First off, I can't see how a single payer system would work any better with regards to paperwork or to "satisfy" insurance companies....IRS, DMV come to mind. The US would in effect become the sole provider of insurance (forgetting for a second that they already provide a greater ratio via medicaid / medicare and have just as much paperwork). The system is alreay bankrupt and it is not just because of rising healthcare costs. Secondly, and I am open to other opinions, but I see the problem as not just PRIVATE vs. PUBLIC but is at least in large part the result of a third party payment system in general. Insurance, by definition, is the transferance of risk. Instead of a system where insurance covers the risk of catestrophic events, such as ER visits or surgeries, we allow them, no, WANT them to cover every sniffle and scratch. The result is that people dont spend their own money. And noone spends someone elses money as efficiently as the individual would spend it himself. It was great for physicians for a while because they didn't have to negotiate with their patients for fees but now docs have to "charge" outrageous amounts in hopes of collecting 40%. I would argue that the best offence is to put patients BACK in the driver seat and let them negotiate with you what they can best afford for your services... Would you really turn someone away who was willing and able to give you $20 for a 15 minute checkup? This would create more dialogue between you and your patient and ultimately improve patient satisfaction and 'quality' of the patient's experience...Again, people don't sue those they perceive as their friends.
A simple tax deductible HSA (with possible tie ins to a low risk mutual fund) with catestrophic insurance would make good incentive for younger people (and others) to invest in health insurance (they make up about 25-30% of the currently uninsured). Making a HSA portable would also reduce the incidence of lost insurance due to job loss (the ability to take it with you, like an IRA with employer matching)--incidentilly another 10-15% of the uninsured. I know I am speaking in generalities and there are many more factors that I am not considering but it is at least makes my point.
"Amen" to Anonymous' writings above, and also suggest readers who have not done so, take a look at Mackey's editorial in last month's WSJ about Whole Foods and healthcare. "Anonymous," with such clear writing as above, you should leave your name so we can recognize future posts.
I agree Stephen.
1. Medicare / Medicaid encourage the unnecessary use of services in clients not responsible for the bill.
2. The programs are, and will always be, bankrupt.
3. So-called "preventativativative" (it's PREVENTIVE"!) care only DELAYS the much higher end-of-life cost, while adding to overall outlays. In short, switching to more preventive care will be even MORE expensive!
4. I have no right to take forcibly take money from anyone for the care of my relatives, and favoring such a system does not make me a better person, and is compatible with the tenets of the oft-misused Hippocratic Oath. Doctors who perceive a duty to care for an entire population are philosophical cowards.
I agree with Anonymous, Pat & Stephen. It sounds great on the surface, everyone having heath insurance but that will trigger even higher medical costs. The reason is that the end user is not directly responsible for the cost of any particular service. Think about it. How much did an MRI of the brain cost 15 years ago?? How much does it cost today?? The same. Now, how much did a DVD recorder cost 6 years ago? About $6-10K if you could get one. Now $39 at WalMart. Why is this?? True market forces at work. In America, the only doctors who truly work under market conditions are plastic surgeons, no insurance urgent cares and some crazy osteopaths who provide manipulative services that their patients value so highly that they are willing to pay cash money out of their pockets. When everyone is covered by insurance, then the insurance companies will truly control all of health care, with the goal of putting an ever increasing profit into the pockets of their shareholders. Even now, as much as they scream about controlling costs, they get a percentage of whatever the cost is and 6% of a Trillion is definitely better than 6% of 500 Billion. Also they are mandated by law to maintain so much in cash reserves per "covered life" which do not count as profit. This cash is invested and that income counts as profit, so when the market crashed, insurance companies had to raise their rates again so that their cash reserve requirement would not be jepardized. So, do I have any answers? Nope, except buy some stock in the insurance companies and further your education doctors, so that you may develop some skills that your customers are willing to pay you for, so that you in turn can repay all those student loans that are keeping you tethered to your highest paying options only.
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