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In China we now short of doctors`````


I like it very much ! thank you.


"Bringing it all back home........"

If........ H/C reform brings with it higher demand for GP's and other docs, assuming, still relatively high pay, and that we trust "the market" surely the problem is self-correcting. Especially so with what seems a long term surplus of labor in many other fields.

My guess? More women going into the GP arena and sensibly dealing with the "long hours and emergency" issues by job sharing and putting to work the same skills used to juggle raising several kids, maintaining a home and perhaps having a job as well.

Immigration is likely to continue to play a strong role as well..... it seems easier to legally get a green card when it's a case of "needed skills" and not displacing existing US employees.

Further? there may NOT be such a crush of new patients. The "right" is often fond of saying "Well, "they" get treatment anyway". True, although in the most costly and inefficient manner possible (so far!) by showing up half dead, or not, at an ER designed for crisis intervention 24/7. Just perhaps more rational care is aided by a much lesser load on the ER's and a much better utilization of the docs and skills we already have.

In any case....... we've LONG ago crossed the bridge of providing (some sort of) H/C to ALL who are sick or injured within our borders, now, it's well past time to do so efficiently and at lower costs; it's hard to chest thump "exceptional US!!" while spending 17% of our large GDP while other nations do cover all of their citizens in the 9-10% range.

And lastly; MUCH is being made of "Medicare being broke". But IF it's "broke" it....... being a more efficient system than the costly overhead of the "insurance" paper mill and its 30% or more overhead, it's "broke" due to the soaring costs of "fee for service" and what THAT means is that our ENTIRE medical system is just as broke. With 17% of GDP growing at rates double that of our base inflation it will get to be 20% or some other intolerable number FAST unless we find a means of curbing its nation tanking growth.

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A symptom of a shortage is queuing—it indicates that the market price is not clearing the market. There is a great deal of “involuntary” queuing in primary-care medicine, in the form of long unwanted delays in getting an appointment with a primary-care physician and refusals of these physicians to take on new patients.



Excellent as always.

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I really enjoyed reading your post. "Remove politics from the issue and view healthcare as a basic human right - then we can make some progress." agreed.

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Some GPs are rebelling by refusing insurance and lowering prices to get cash payments. Others are setting up "concierge" practices in which patients pay a flat fee for their routine medical care for a year. These practices reportedly fill up quickly. In addition, many physicians will give discounts for direct pay because it costs them less than the insurance paperwork and the administrative staff it requires. Clearly there is a desire on the part of doctors and patients to return to the practice of paying for our own routine medical care and carrying insurance for catastrophic events. Why isn't this on the table in the discussion of "reform."

Alan Robinson

As a person who has bought insurance on their own, with both $500 and $2,600 deductible policies, I can explain "Why anyone should want health insurance other than “major medical”—that is, insurance against catastrophic medical bills."
When I one buys health insuranc, three different products rolled into one are purchased. 1) The first product is the services of a third party to negotiate rates for services with doctors, hospitals, pharmacies, and medical equipment suppliers. 2) The second product is an income appropriate catastrophic medical insurance. 3) The third product is a savings product or pre-payment product.
The size of the deductible determines how much of the the third product one is buying. In my case, the difference in premium between the $500 and $2,600 deductible policy was more than the difference in the deductible.

Now there are two additional wrinkles in this process. First, the ability of an insurer to negotiate rates with medical professionals is somewhat tied to the size of the deductible of its policies. This is because individuals with high deductible policies only pay about 50% of their outstanding bills. (It is worse for the uninsured.) As hospitals have to cover their costs while either waiting for payments or writing off bils, then these costs go into higher prices for the ensured.

Second, individuals that are healthy who have high deductible policies tend to not save the difference in premiums as their perception of the risk of illness is much lower than it actually is. It is the same reason that disability insurance is so hard to sell and retirement savings levels are no where near the levels neccessary to cover retirement living. This then forces us back into the standard endemnity policies as those are the policies that are most likely to ensure that the medical service provider, and in particular the highly paid specialists get paid what they want.


LMF -- my guess is that of it being too silly.

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Inflation also reduces the real, as opposed to nominal, value of the US debt in the hands of the public.

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I had this entire post I wanted to write months ago about telling ourselves no, just like we tell our kids no. If I wouldn't let Kyle have three helpings of dessert, why let myself? I know what's best for him but I apparently don't know what's best for me? Crazy talk! I do know! Sometimes he does get chocolate milk for breakfast and sometimes so should I, but not for every breakfast, no sir, because that's kind of crazy irresponsible. (And expensive, I'd think.)

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

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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.

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Well 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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