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From: Mark Conrad on 28 Dec 2009 23:26 In article <1jbgkmb.gw8k7z1f81dp2N%jamiekg(a)wizardling.geek.nz>, Jamie Kahn Genet <jamiekg(a)wizardling.geek.nz> wrote: > Certain services are simply better run by > government rather than as a for-profit company. That is what the main topic of this entire thread is about. Heck, even hard cases like me would support "switching" control of health care over to government/political control if we really thought that the actual effect of the new health bill would be what we the people expected it to be. There is the possibility that if the health bill was rotten in actual practice, that we might be able to switck back again, like you New Zealanders did with your railroad; in our case losing trillions of dollars in the process, and financially ruining the USA, which would make a lot of Muslims very happy. hmm, Obama has Muslim leanings, doesn't he. Now I have a question for all here. If we made a pie chart about who presently REALLY controls health care right now, what would the chart look like? Many libs here claim that say 90% of health care is controlled by the evil insurance companies. Others claim that the private doctors have a large amount of control, say 60 %. Others claim that government agencies like medicare and medicaid call the shots, say 60%. Others claim the big drug companies do, say 52% Yet others claim the malpractice lawyers control things, I suspect a lot of doctors who have to pay $100,000 yearly for malpractice insurance might agree with this view. I read about a Florida gynecologist having to pay $250,000 yearly for insurance. The percentages just do not add up, can we clueless peons get people in this thread to somewhat agree on who actually calls the shots? I will start it, here is my guess: 40% goverment agencies, medicare, medicaid, FDA, etc. 20% private doctors 18% private insurance companies 12% lawyers 7% drug companies 3% misc medical labs etc. Notice I already have government control as the top dog in running health care, very few things would work in our system without medicare money greasing the skids. So the unfortunate doctors, in my view, have very little to say about running their own business. Contrast this with say a plumber, who controls maybe 80% of what goes on in his business. Mark-
From: somnambulist on 29 Dec 2009 02:25 In article <231220092058574529%aeiou(a)mostly.invalid>, Mark Conrad <aeiou(a)mostly.invalid> wrote: > We could easily make health care much worse by > picking the wrong people to regulate it. > > What is your suggestion for that gnarly problem? I've been following this thread and will briefly delurk to provide another perspective. I've been practicing neurosurgery for 30 years, and every male member of my family has been a doctor since the 1860s, so I have some historical perspective. There is no simple solution, private or public sector, to providing healthcare, let alone healthcare to all. So here's the perspective of one practicing doctor: Health insurance was rare prior to the 1930s. Medicine just wasn't terribly effective, and with the exception of surgery, was fairly inexpensive. Doctors functioned as a mini-bank for their patients, charging the poor little or nothing, and the wealthy up to 10 times the fee for the poor. A major operation would typically cost a month of a man's salary. When the Depression hit, hospitals established the Blue Cross programs to try to ensure that they would receive some compensation for their services, and doctors established the Blue Shield programs with similar motives. When wage and price controls were in effect during and after WWII employers sweetened salaries by providing insurance "off salary". During this period and up until Medicare was established in the mid 1960s, the rate of medical inflation closely tracked the general inflation rate. After the Medicare act, the rate of inflation in the medical sector of the economy began to diverge sharply from the overall rate of inflation. Few remember that during the Nixon administration there were wage and price controls, and that these were lifted from the medical sector of the economy last. The market distortion of divorcing the payor from the purchaser of insurance was well established by the time of the economic slump of the early 1980s. During the Reagan years the concept of promoting medicine as a competitive business rather than a profession was pushed hard and we saw the rise of for-profit medical corporations - hospitals and insurance - and the decline of medicine as a profession. At the same time, a parasitic class of people whose primary concern was financial saw that money was still flowing in the medical sector of the economy, and the definition of medical care began to be defined much more widely. Lobbying to expand what was considered to be necessary treatment was largely successful, and new treatable conditions were defined. Gradually Medicine became an "industry", and we all became its widgets. At the same time, in the 1975-85 period saw a dramatic expansion of expensive technology (CT and MRI) which made medicine much more effective and allowed screening of populations with minimal risk compared to older invasive diagnostic procedures. The insurance companies fought back with managed care (another idea of the Nixon administration) and hiring "deny-ers" who work with a cookbook script of what to allow or deny. We've all heard of the lousy decisions some managed care companies have made, and their repercussions. What hasn't made the news is that the managed care companies which have tried to maintain a reasonably good reputation have suffered from the problem of increased costs to about the same extent as the non-profit and for-profit insurers have. So there's a lot of blame to go around on both sides of the political spectrum for the fix we're now in. As a doctor I have to think about my cost of providing medical care. I try not to think about it more frequently than every two months, so as to avoid depression and avoid skewing any decisions. Medicare covers about 30% of my fees, welfare covers about 20%; I haven't raised my fees in 8 years, because the only effect of doing so would be to write off more. I currently collect about 47% of my charges. The cost of my liability insurance is 5 times what it was when I started practice, and dealing with insurance companies' telephonic deny-ers has forced the doubling of my office staff. A few years ago I took home less one year than my liability insurer did from my labors. Not because of my history - I've been sued twice in 30 years, which is about 30% of the average for neurosurgeons. I've read portions of the house and senate bills, and I find them discouraging. Both versions seem to promote medicine as a big business, rather than a personal service, which I prefer to think it is, or ought to be. Both versions and also the "public option" directly or indirectly will result in downward pressure on providers of medical care - doctors and nurses - and none of the solutions seems to address adequately all of the parasites attached to the money flow in the medical sector of the economy. The result is going to be a decline in the average quality of medical school applicants, which my friends who are residency directors tell me is already occurring. Portions of the legislation already passed this year relate to electronic records, with payment incentives and penalties relating to their "significant use". The government hasn't clarified which EMRs will qualify or exactly what "significant use" means beyond electronic prescribing, but sharing some of the doctor's patient data with the government is expected to be part of the program. So whoever the payor is, there will be pressure on doctors to conform to a standard which is financially oriented. Whatever happens, a few things are certain. The increased complexity of medical care and medical technology costs will forever prevent getting back to the day when patients could individually afford to pay for their medical care when they are sick. So some form of risk sharing is necessary, whether governmental or private. In a few years it's going to be harder to actually see the doctor; it will be the age of mid-level practitioners. And either medical care will cost more than it does now, or access to some treatments is going to be curtailed, either at their development stage or at the delivery stage. We still have a somewhat active press in this country, and it may need to be muzzled, because the cheapest treatment is the one no one has ever heard of. We are entering an age of scarcity of many resources, medical care is just one of them. Learn how to try to stay healthy. And hope for the best. Some problems have no solution, some stories do not have a happy ending. Back to lurking. (and per the original topic, I like Safari) -- armackay Alex MacKay
From: Mark Conrad on 29 Dec 2009 04:33 In article <see.signature-F2A243.23254828122009(a)news.qwest.net>, somnambulist <see.signature(a)uswest.net> wrote: > > What is your suggestion for that gnarly problem? > > I've been following this thread and will briefly delurk to provide > another perspective. > > I've been practicing neurosurgery for 30 years, and every male member > of my family has been a doctor since the 1860s, so I have some > historical perspective. > > There is no simple solution, private or public sector, to providing > healthcare, let alone healthcare to all. > > So here's the perspective of one practicing doctor: <snipped very interesting perspective> Thank you very much for your post. Parts of your post are very depressing to me, the part where you post that medicine is no longer a profession, but is now an industry. I find that very sad, trying to use a doctor as a mere hired hand to follow orders, rather than a respected professional. Isn't that what communism is all about? "each person works and is paid by their abilities and needs, as determined by czar Obama" "My name is Obama, you _will_ bore open this man's skull with my politically-approved low cost portable drill from WalMart, repair his aneurysm, and oh yes, sweep the floor of the stockroom afterwards". From the little I read, the new health bill is attempting to herd all the doctors together into one large cattle call, uprooting them from their private professional practices with a combination of penalties and encentives, because that makes it a lot easier for the CC (Congress Critters) to control them as hired hands when the doctors are in one large standardized group like the Kaiser-Permanente group. I actually wonder why anyone would choose to pursue a medical career these days, there is little incentive. Mark-
From: Kurt Ullman on 29 Dec 2009 06:38 In article <hhbkgp$nq1$1(a)news.eternal-september.org>, Wes Groleau <Groleau+news(a)FreeShell.org> wrote: > AV3 wrote: > > On Dec/27/2009 11:4206 PM, Wes Groleau wrote: > >> He also promised to do something about "ear-marks" which make up > >> a large percentage of what the House and Senate have passed. > > > > This is not relevant to the merits or demerits of the health care bill. > > It most certainly is relevant. We could have had a hundred page > reform bill passed nearly unanimously months ago, if those claiming > to represent us had agreed to table any point on which consensus > couldn't be reached quickly. Instead, we have thousands of pages > which almost half of both Congress and the country is fighting bitterly. > > In other words, we could have, months ago, had _some_ reform. > Everyone would still say it's inadequate, but everyone (almost) > would agree it's a start, and everyone (almost) would like it. > > And THEN we could argue about the hard parts. Actually years ago. The lesson that was learned from the Clinton attempt was that the American public wanted this done in public instead of having an entire plan hatched and presented from the White House. What SHOULD have been learned (and apparently still hasn't) is that the American Public wants incremental change not fundamental change. -- To find that place where the rats don't race and the phones don't ring at all. If once, you've slept on an island. Scott Kirby "If once you've slept on an island"
From: Kurt Ullman on 29 Dec 2009 06:54
In article <281220092026079190%aeiou(a)mostly.invalid>, Mark Conrad <aeiou(a)mostly.invalid> wrote: > > > If we made a pie chart about who presently > REALLY controls health care right now, > what would the chart look like? Ask and ye shall receive: http://lahealthaction.org/library/HealthCareCosts07.pdf Actually a whole bunch of really neat pie charts. This is from 2005, but the %ages are fairly stable. One personal caveat on the chart about inflation. There are generally three parts of health care inflation, that aren't broken out. One is core or CPI inflation (what the general economy is experiencing). Two is case load inflation (extra demand and thus some demand-related inflation that comes from an aging population that requires more and more expensive treatment) and the "excess" inflation which is basically any left over. > -- To find that place where the rats don't race and the phones don't ring at all. If once, you've slept on an island. Scott Kirby "If once you've slept on an island" |