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07/03/2011

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Heart and Vein Center

Interesting article, it really makes someone think. I always like to read thought provoking articles about things like this. Keep the great posts coming. Thanks again for sharing it with us.

Jack

"The health care reform legislation recognizes that the shortage of primary-care physicians will get worse, and that this will reduce the quality and increase the cost of medical care generally, but it doesn’t do much about it."

............... Well, we aren't so sure of this. Many of the "right" claim those uninsured get medical care by one means or another. While it's hardly ideal, they do have a point. "They" often get urgent care at ER's along with some poverty related clinics. Surely there will be an increase in efficiency and efficacy of patients actually being able to get care before a situation becomes chronic.

If, as Posner mentions, many young patients need better H/C education, such could easily be accomplished to the benefit of all, by showing a video in a group setting with a nurse to answer questions or even by providing such on the internet.

IF........ as does seem the case, "third party payment" greatly favors "specialists" over GP's why do we tolerate it? And, Ha! while considering our having next to NO control over our insurance parasites, let's go ahead and consider what, if anything, they bring to the H/C party that's worthy of the storm of paperwork and real dollar overhead?

By now IF they wanted to be in the medical sphere to provide a service, they've plenty of capital with which to create competing HMO's and such.

Given how our immigration laws work (green cards for those in "needed specialties") if we don't grow our own cadre of physicians I'm sure the ranks will be filled by Indians, Chinese and others.

Jack

"If the shortage of primary-care physicians persists, queues will lengthen, and perhaps care will be rationed in other ways as well."


........... One hopes the current mess of "some" being "rationed" as in the status quo is not Posner's ideal. BTW who IS "left out?" Not those on welfare, not government employees, nor military of any rank, not those with large corporations. No, largely it's those of the very "small biz" sector that gets lip service as the driver of innovation and much of the job creation.

As there is often the same problem for mid-life employees who might rather strike out on their own, access to med care, regardless of "pre-existing conditions" many mid-life folk often have, the availability of H/C should be something of a spur to economic creativity and entrepreneurship.

John

“…but a person could achieve that smoothing simply by saving the money that he now pays in health-insurance premiums and investing it to create a fund out of which to pay future health expenses as they occur.”

But since some people will not [save and create such a fund] self-directed smoothing will become soon illegal for everyone. Another step towards greater economic efficiency.

Jack

"Why anyone should want health insurance other than “major medical”—that is, insurance against catastrophic medical bills—is a great mystery, as is the fact that Medicare subsidizes routiine health care of upper-middle-class people. Since disease and injury tend to be unpredictable, health insurance smooths costs over time, which is efficient, but a person could achieve that smoothing simply by saving the money that he now pays in health-insurance premiums and investing it to create a fund out of which to pay future health expenses as they occur."

A few answers:

1. Because the unpredictable nature of h/c costs can take place well before any savings can be accumulated, while most insurance programs cover within a few months.

2. "Small" (if any medical events fit that term today) can happen frequently and become a financial burden to one indidivual. (The reason I carry auto insurance and hope never to gain from it.)

3. The (former?) middle class is running so close to the bone that even "small" shocks to the budget cause a lot of distress -- a reluctance to gamble with scarce margins.

4. In "our world" employers have purchased group policies (somewhat) efficiently, thus if the were willing to rebate the premium to the employee it would not likely cover either privately purchased insurance (major or other) nor the, often inflated fees charged to individual rubes in the dark forests of US medical care.

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Health care reform is a general rubric used for discussing major health policy creation or changes—for the most part, governmental policy that affects health care delivery in a given place. Health care reform typically attempts to: Broaden the population that receives health care coverage through either public sector insurance programs or private sector insurance companies.

John Goodman

The 20% increase is in the number of privately insured, not total insured.

The 10% increase in payments is for Medicaid (brought up to Medicare rates for a few years), not Medicare.

The problem with licensing is that it inhitbits nurses, paramedics, etc., from performing tatsks they are competent to perform. It's the medieval guilde in the modern era.

Jimbino

If you can't find simple answers, you aren't looking very hard. Here are a few:

1. Require all healthcare providers to post prices by CPT code for all procedures they offer on the Web. These price lists are available (though the gummint, the AMA and providers seek to hide them) for Medicare and Medicaid. You may have to file a FOIA request to get them, as I did here in Texas.

2. Require all healthcare providers to give discounts to patients that fairly reflect services foregone. For example: discount for cash payment in lieu of insurance (worth up to 40% in savings to the physician), discount for cash vs credit card payment (worth some 3%), discount for filling in for no-shows (my dentist gave me 10%). I'm sure you can think of others. I have seen a doctor twice in my adult life. Both gave me discounts because I had diagnosed my own self-limiting diseases (pityriasis rosea and HEP-A). I paid the two a total of $25.

3. A la Milton Friedman, kill off all licensing and certification. I am a physicist who does my own construction, cabinetmaking, plumbing, and electrical installation. My partner is a nurse, who examines me every day! Why can't I do my own diagnosis and self-medication (or hire Mexicans or seek care in Hungary, Czech Republic, Thailand, Mexico, Costa Rica or Brazil?)

I'm not an idiot who pays whatever a mechanic, electrician or plumber thinks he's worth. Why should I be forced to deal with physicians, dentists, hospitals or nurses on their terms? Hell, I edit medical writing professionally, and I hesitate to submit to treatment by a medical worker who doesn't wash hands after using the bathroom (the majority), who says "at risk for ..." when he means "at risk of ..." and who denies women abortion or morning-after pills. I am fully aware of iatrogenic and nosocomial illness and will not participate in an Obamacare that makes me participate in acquiring and spreading them.

4. Encourage Amerikans to seek treatment and spend their healthcare dollars overseas, where treatment is often better and far cheaper. Do you know that there are come 15M Amerikans who reside overseas, who are liable to pay federal income taxes on all income from wherever derived, some who have paid lifelong Medicare FICA taxes and some who will have to pay Obamacare penalties, who are entitled to ABSOLUTELY NO Medicare or Obamacare treatment where they reside, whether in France, Costa Rica or Brazil?

Cartools

I get what you said. thank you very much!

El-Greco

"...Do you know that there are come 15M Amerikans who reside overseas, who are liable to pay federal income taxes on all income from wherever derived, some who have paid lifelong Medicare FICA taxes and some who will have to pay Obamacare penalties, who are entitled to ABSOLUTELY NO Medicare or Obamacare treatment where they reside, whether in France, Costa Rica or Brazil?"

They have a problem though. They are a mere 15 million against 300 million voters who want, and can take, their money with a simple vote. Democracy + Collectivism at work.

When 300 million want the money of 15 million, they'll find the morality of taking it.

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The problem with licensing is that it inhitbits nurses, paramedics, etc., from performing tatsks they are competent to perform.

Gordon Longhouse

In Australia we experienced a shortage of doctors because of the determination of newly graduated doctors to no longer work the punishing 60 hour plus work weeks of the previous generation. Female doctors wanting to start a family may have been a factor as well. That is the numbers were adequate but they did not work sufficient hours to meet demand.

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Hello,I love reading through your blog, I wanted to leave a little comment to support you and wish you a good continuation. Wishing you the best of luck for all your blogging efforts.

joshua blumenkopf

The reason why people have non-catastrophic health insurance is that once you buy catastrophic health insurance, the insurance agency has an interest in making sure you don't get really sick, so they essentially subsidize non-catastrophic insurance to keep you healthy.

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Jim

The country (at least the do gooders) wanted a more controlled, regulated business-like medical system. They got what they wanted and will have to deal with it, ie higher cost, lower quality, less access. If you need a new hip or knee, probably no problem but if you need a knowledgeable, caring, thoughtful MD to listen and analyze what your diagnosis is, good luck. My advice is to not smake, drink, use drugs and to eat a balanced diet of only caloric needs, exercise moderately, get enougjh sleep and minimize stress. Gee how much do you think I can get paid for that?

Observer

given the fundamental structure of the American health care system, which is unlikely to change in the foreseeable future.

And whose fault is such?

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Jim

Your Honor,

Do you think that paying primary care physicians more will get better ones or do you agree with your recent WSJ article that paying judges more will not get better judges? After all, human nature is human nature.

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Remove politics from the issue and view healthcare as a basic human right - then we can make some progress.

Jack

Jim --- Mebbe you've got something! Seems even our military generals in charge of hundreds of thousands top out well under $200,000 while just some hack running an insurance parasite operation routinely carves off $10 million or more. Think that if we were to pay our Generals, even a million or so, we'd get such better management as to lay off half the military? get good results and save a lot of dollars?

How 'bout our teachers? Seems the national median is something around $30,000 or so. Think we might be getting the "dregs" who couldn't cash in elsewhere? Or? Do "we" think they're so devoted as to take a vow of poverty and slog on regardless?

Andy

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