1 Despite the horrible example of Hasan, expand military medical training programs.

2

Posted by: reviewups at December 02, 2009 02:35 AM (fZN4w)

You're supposed to type First, you idiot.

3 I thought the problem was lack of insurance?

4 Increasing supply will work to reduce unit costs, but unless demand goes down the total cost to the economy continue to rise. People need to understand the costs of their health care -- co-pays should be percentages of the procedure - the flat rate copay does nothing to reduce marginal demand for additional tests (defensive medicine).

5 A long post?  Pfft.  Ask Russ in Winterset.

6 Offer a federal malpractice insurance pool with a very tight payout regime and a special master (highly trained judge) to review malpractice suits. Esp. for OB/GYN and other specialties. If there are no deep pockets to sue, the lawyers will go away. If it involves a federal payout and a special master gets to medically review the facts, rather then a tort friendly jurisdiction, the lawyers will run away.

7 Dumbasses, don't you know that obama's main problem is that he is too Spock like and he therefore already considered this?

8 This is an insulting post. The idea that the "market," filled with millions of individuals, only some of whom are democrats, would know better than our esteemed, brilliant, successful, statesman president is just laughable. And what is this crap about supply and demand? President Obama (pbuh) will decide for us what we need, and he'll do a much better job than some amorphous "market."

9

My wife is an RN and she says that the thing she thinks would make the most difference is non-hospital preventitive care/light-care clinics. She pointed out that this flu season was a perfect example of a mass of "sick" but managable people clogging up the ER and using up hospital resources needed to treat more severe sickness and injury.

It may seem like a little thing but poor people know they can show up at the County ER and they'll get treated and they can never have to pay for it. If we had a intermediary level that they had to go to before admission into the county ER, you could better treat the severely injured and ill and not get bogged down by the person who just needs a suppository and some advil.

Her point is that we already have a form of government healthcare that the lower income have access to. In light of that, we might as well triage them better so that the life threatening situations aren't made worse the manageble aliments.

10 huh?
The premise is correct -- demand outstrips supply, but I think the problem is on the demand side. Demand is high because marginal costs approach zero. Most of the country is on an employer paid insurance plan, or a gov. plan (Medicare, Medicaid, VA). For this group the cost of using more of that limited supply is not reflected in the marginal cost to them. They do not know what a procedure costs and generally do not care too much about the copay since it is such a small percentage of the total.

On the supply side, however, never forget that the AMA (et al.) is a trade union and its job is to restrict the number of entries into their guild. They have accomplished this through accreditation processes, immigration laws, etc. etc. Any "shortage" of health care professionals is intentional and reflects the highly regulated market created by the government.

Third point, is that if these hospitals were truly losing money they would go out of business. They don't, so you have to ask why? Are their employees taking pay cuts or working for free to keep them afloat? no, that's not it. Maybe they are selling off assets? No,.. not that either.

But any "business" that is losing money has to do something to make up the difference and they are not. For decades these hospitals have been losing money. Reminds me of the f-ing farmers -- we ought to have a concert for them,

"losing" money is part of their business plan -- it keeps the government funds rolling in and keeps the heat off when others complain abu thte high cost of insurance.

11 In my own case I have noticed that my desire for expensive services goes down dramatically when I reach the doughnut hole and I have to pay for them.  I believe that there is a huge demand for expensive services that can only be reduced by high, up front, copays.  The answer is definitely not to be found in taxing some and making the services "free" to others.

12 First? Tort Reform, to lessen the defensive medicine that drives up demand for services, and with it, cost.

Second, Insurance Reform, to allow companies to sell insurance across state lines, increasing supply and encouraging competition, which will reduce cost.

Third, use the Interstate Commerce Clause to eliminate state mandates, just as we would eliminate interstate tariffs. Let consumers choose how much coverage they want, and are willing to pay for. This will serve to drive down costs as people come to realize they really don't need "Cadillac" plans, especially if they are young or healthy. It will also allow those of moderate means to buy insurance that covers only what insurance is designed for: catastrophic diseases or injuries. This will also lessen drastically the number of "uninsured."

Fourth, continue Health Savings Accounts. Combined with high deductible plans, the young and healthy will be able to reduce costs while still providing adequate coverage.

Fifth, increase supply by letting doctors deduct the cost of medical school from their taxes. A doctor starting out with $250,000 in debt, would also have $250,000 in tax credits. If he earns $150M per year, he should pay about $35M per year in Federal taxes - the tax credit would eliminate that, making it a LOT easier for him to pay back his education costs. In fact, after 8 years of practice, he should have paid off his college loans, and be back to paying taxes like the rest of us.

Is this a subsidy? Yes, but I don't really see how it is more reprehensible than, say, a tax cut for businesses (I favor a 0% tax rate for businesses, BTW, but that's another discussion entirely).

Sorry for the length of this post, but I've had a lot of caffeine this morning.

13 Hey, look at that...free shoes!

As a footnote (d'oh!) I'll mention that my employer opened a medical school circa 2000. I'll also mention at the time, this was billed as the first new medical school from the ground up opened in 25 years. And that their focus would be on general practicioners and gerontology.

You're right, supply is the problem. One of the problems is the AMA and the "doctor's cabal" that want to keep demand for their services high. Probably to insure the ability to pay for their debts incurred in getting the MD in the first place. If we can solve the that problem, they'll probably be more interested in boosting the numbers of physicans available.

14

There are 50,000 D.C.'s in the U.S. who could take over many of the primary care tasks with just a course in pharmacology.  That's being done in Oregon and it seems to be a good program.

15

The only feasible answer to higher supply comes from the same place it comes for so any other things: technology.

90% plus of doctors are information processors. Unfortunately, we long ago passed the point where a doctor can hold everything he/she needs to know in a human brain.

We need to be rapidly moving to a diagnostic process that is far more automatic and technology centric, and isn't tied strictly to a doctor's office. We're already seeing the early phases of this. A company named Lifeline sells a battery of tests for just over a hundred bucks that checks some common things such as cholesterol buildup almost as easily as you check blood pressure on the machine at the grocery store. It's pretty easy to envision this getting to the Star Trek level of automated diagnosis in a few decades, and sooner for the most routine conditions.

So our tests will get better and better, including genetic tests that indicate all kinds of predispositions. No human brain will ever be able to correlate that data and sift through the possible diseases and conditions. It will take sophisticated programs, based on data-mining technologies. We will need a critical mass of clinical data to do the mining, but after that programs will do a far better job of diagnosis than 98% of all doctors for 98% of all cases.

In twenty or thirty years, doctors will spend most of their time feeding results into diagnostic programs and getting back possible diagnoses and suggested tests to narrow them down. Their expertise will be in doing tests, gauging test results, and putting the results into the diagnostic programs. They will need to be better at the part of their job that machines can't do: communicating with patients, counseling them, and helping them understand what they need to do to treat their condition. Believe me, they don't teach much about that in medical school (or at least they didn't when I was there in the late 1970s), but that's just one of the ways medical education will have to change.

The main exception will be surgery, but there robotics will transform much of what they do. I wouldn't be surprised, though, to see a major career path split between surgeons and other doctors. Perhaps eventually a different degree.

We already have nurse practitioners taking the diagnostic role because doctors don't have the time to do the basic grunt work. It's possible that we'll see an in-between specialist, with more than a nursing degree, but less than a full MD, with emphasis on the kinds of activities I discussed above. Think of it as associates degree for medicine.

Plus robotics will become a big part of elderly care and other routine things done by nurses now. This is already starting in Japan. With our perpetual shortage of nurses, it's inevitable here too, as long as one condition is met.

You can probably guess what that condition is: no government takeover of healthcare. Such a takeover damps innovation (by spiking much of the profit incentive) and creates interest groups such as nurses that block needed change, just as teachers block needed changes in the educational system today.

I need to write a full blog post about this at QandO, but I have not had the time. Maybe during the holidays.

16 10 and 13 have a combination of ideas that would affect the system greatly. First, let me say how important this point is: the spiraling cost of medical care will only continue upward for as long as people are willing to pay for it. Your supply and demand argument is spot on - as the opportunity cost of an additional unit of health care increases, people will begin to demand less. So that whole hockey stick is goofy.

As to reforms that would work WITH the market: tort reform is critical, and only with tort reform would the following idea work. ERs are the "safety net" of health care right now. This is bad. This is expensive for hospitals and doctors and insurers. Give hospitals incentives to build primary care facilities - cash from the government to set up the space, etc - near their ERs. With tort reform, allow hospitals to triage the patients that come to the ER with non-emergent issues over to the primary care clinic. Give physicians and nurses and most especially the efficient resources of the nurse practitioners and physicians assistants incentives to work in these clinics. Forgiveness of student loans, tax incentives, etc. Give hospitals continuing "bonuses" for patient traffic and quality of care in the primary care facility.

Those changes alone would massively reduce the cost of primary care, reduce the financial burden of non-reimbursement care, and would increase the efficiency of ERs, dropping the hospital overhead significantly. Access to care would increase for the uninsured and underinsured.

Add in reform in the insurance market (nothing like what is being discussed - simply opening up the market by allowing cross-state competition and more, not less, flexible plans in terms of cost sharing) and the supply/demand balance in health care will manage the rest.

17 At the risk of sounding like a male chauvinist pig....

Twenty years ago, my medical school class was comprised of about 50% females.  Most certainly, those women proved to be capable students and colleagues. 

Now that I have been in practice for two decades, I cannot help but notice the status of the female MDs who reside in my home county:
Half are not working at all, by their own choice.  Most are married to male MDs, who are still laboring.
Of those who are still practicing, all are in salaried positions rather than self-employed; i.e. - not entrepreneurs. 

Reminds me of the line in "The Official M.D. Handbook:"
Going to med school to find a mate is like climbing Mt. Everest to get a breath of fresh mountain air.

The ACGME has been "rationing" residency slots for decades, ostensibly to limit the number of costly specialists.  They failed to recognize that many of those newly-minted specialists would not remain in the work force, actually attending to the needs of patients.

Disgusted by cutbacks in reimbursement, rationing (pre-authorizations by twits with GEDs), and the omnipresent threat of litigation by wealth-transferers (trial lawyers), I and many of my male contemporaries intend to retire early.  Get ready to wait for your care!

18 The statement about every hospital in the country losing money is false. Hospitals are required to spend millions a year in maintenance on their equipment, for example, to allow them to remain certified. You cannot do this if you are losing money unless it's funded through borrowing. Obviously, constantly increasing borrowing is not what's happening. Many doctors are indeed paid quite well--some too well. This is part of the problem. Reimbursement rates for highly specialized procedures are higher than routine procedures. As it should be. Yet this drives med students into specialties not based upon demand, but the likelihood of earning a large salary. As it relates to demand/supply issues, veterinary costs have been rising at about the same rates as human health care over the past decade. It would appear obvious that the demand is based upon similar factors: new treatments that cost more becoming available and/or old treatments being bid up due to increased usage or larger numbers of consumers. Pricing is a bit of a canard, in that pharma companies spend so much time in the approval phase of drug invention that the time at market under protection has become condensed to less than half the patent life in many cases. To get the economic return they need, the drug companies must charge high prices. This will not change, regardless of reimbursement rates or demand under ZeroCare. My guess is the pharmas will ultimately do under socialized medicine is what the doctors do: and specialize on more esoteric but more valuable drugs--especially those for P.C. diseases like AIDS. Extending drug patent life here and abroad would be one way to lower drug costs, but that would require our cowardly politicians to stop denigrating drug companies. Hospital equipment is vastly expensive and overused as part of a defensive medicine strategy. Tort reform would help here as well. It's a complex issue. Opening the doors open a bit wider a medical schools would be a good start. Good luck forcing that one on the docs. These guys are obsessed with their incomes. It won't be easy.

19 Don't forget to reform the FDA.  It costs $1 billion to bring a new drug to market.  They require that ALL data be US studies and results be presented to them on paper (truckloads of paper, at least they did as of a few years ago) thus driving up the cost even higher. 

Also, scrap the Medicaid Rebate piece of the HIPAA law.  It drives up the costs of drugs to everyone (I could tell you how but it would bore the shit out of you).

20

Everyone who attended a large university and has had to make use of the "Quack Shack" has seen a glimpse of ObamaCare.

 

21 You like me! You really really like me!

22 It's possible that we'll see an in-between specialist, with more than a nursing degree, but less than a full MD, with emphasis on the kinds of activities I discussed above. Think of it as associates degree for medicine.

Doesn't this already exist in the Physician's Assistant? 

The main cost of health care is not the costs of doctors.  It is the costs of testing, hospitalization, drugs and supplies that have inflated over the years.

Don't forget the cost of the paperwork.  Not just patient records for clinic use, but insurance and government paperwork.  Out of hand.

23 The One would probably support making the prospective lawyers pay higher tuition to subsidize the tuition for the Med students.

If he's just going to focus group Tort Reform he might as well just make the eventual trial lawyers pay for the education of the doctors they will eventually sue.

24 Don't forget the cost of the paperwork.  Not just patient records for clinic use, but insurance and government paperwork.  Out of hand.

Is this factoring the recent study that concludes turning all this paperwork digital still won't cut the costs of completing the accounting?

To me this is a strong indicator that a top priority should either be a streamlining of the paperwork or the creation of specialized medical accountants.

25 Since the wash out rate is so high, what about lowering the standard of accreditation? Or is the dilution of talent too great in that instance? Would that harm the quality of health care too much to consider it?

I suppose that would depend on the quality of the washed out. Is there anything that can be implemented there? Perhaps some continuing education after school, that people below a certain level would be required to participate in.

The only reason I mention this is because people are different in school. I know I have an easier time working on an actual solution, rather than an out of the book example. But I realize that a lot of the training in medicine is hands on training.

26

My remarks on this are going to stick primarily to doctors... I have less experience with nurses, and don't want to speculate too much.

Must... resist... punchline...

27

I will give you one reason the supply of doctors can be increased quickly on the cheap: I know atleast 5 people who came to US on a work visa, and had spouses that are qualified doctors and surgeons and dentists with years of experience. The problem is that AMA does not recognize their foreign credentials and forces them to go through 6-7 years of further studies and internships before they can practise medicine. By that time, the spouse's work visa expires and the couple heads back home. There are thousands of such good doctors who are twiddling their thumbs at home, and would love to practise medicine. A six month class that teaches American medical practices, followed by a gruelling exam and interviews with some senior doctors should be enough to give these doctors the greenlight to practise, but AMA does not want that.

28 Really good ideas from all. 13 sounds a lot like the start of Sarah Palin's plan, but then goes deeper into good ideas. One thought missing is getting the size of the market right. How about getting rid of the biggest user/abuser of the ER system, the illegal alien horde? They don't use regular doctors because they can't afford it, but they can't be turned away from an ER. Therefore, if the only tool you have is ER, then you use ER to fix every problem that can't just be ignored. Oh, and enforcing immigration policy would tend to reduce unemployment also. I'll guarantee that the illegals in Houston have a lower unemployment rate than they do in the city of New Orleans. And by the way, I am not at all against immigration. I say let Congress double the rate of legal immigration, and even double the staff of folks that work for immigration. Just don't do it as a reward for people's illegal actions. Why does Congress never consider this action? Why must they always pander to future voters instead of doing something that they already have within their power. (but of course the starting premise of that question answers itself).

29 Is this factoring the recent study that concludes turning all this paperwork digital still won't cut the costs of completing the accounting?

Yeah...even ignoring purchase/maintenance costs of running a digital system, full-time personnel doing data entry/analysis aren't free.  My dad just started working for a hospital that has tablets for doctors and nurses to record what they do/find during exams (I'll have to ask him if that's cut down on the time he spends on records after hours), but there's still a whole department full of people who do nothing but process that information into the formats governments and insurance companies require.

I'm amazed at how many people (in general, not here) don't realize how much of their bill is overhead and just rant on about "greedy doctors."

30 And why are NONE of these ideas even considered by the authors of the healthcare bills? Because these ideas don't pander to unions! Because these ideas don't BUY ANY VOTES! I's almost like you're REALLY trying to fix the problem instead of making politicians more successful. WTF?

31

in a recent case of a family friend, she practiced for five years and decided being a mom meant more to her than being a doctor- despite her remarkable talent.

Blesss her priorities-in-the-right-place heart.

 

32 the illegal alien horde? They don't use regular doctors because they can't afford it

Based on remittances to their home countries, I suspect many of them could afford it, they just choose not to because they don't have to.  They're consumers making rational choices based on market options, just like everyone else.

33

A very fast and easy way to boost the supply of medical care - allow pharmacists to prescribe all but Schedule IV drugs.  They already have all the drug training and knowledge that Doctors have, if not more, and this would cut out all the people who are forced to pay for an office visit and a pile of tests when they just need a simple interview to know whether they need antibiotics for an inflamed cut or some other simple problem.  

Right now, someone without resources in that situation either does nothing because of the cost or waits until it's terribly infected and goes to the emergency room without paying, which burdens all of us.  Why not let them just go see a pharmacist and get what they already know they need without all the extra hassle?

(yes, I know the real answer is because it would cut into the AMA's monopoly powers and they won't give them up without a fight)

34 Part of my vision for health care reform would be a more retail approach to routine medicine. Imagine chains of retail general practice health care outlets that would offer basic medical services; routine exams, treatments and prescriptions for colds and flus; vaccinations... in an environment like CVS or Lenscrafters. People could pay for these services directly, or through some kind of subscription service. It would encourage a system under which people would pay for routine care, and insurance would be reserved for major events; the way car insurance covers accidents, not oil changes.

I would also establish a system by which physicians could form cooperatives that would receive tax breaks and a high level of immunity from malpractice suits in exchange for treating 20% of their patients at low or no-cost. There patients would be issued biometric ID cards identifying them as low-income/disadvantaged.

35 Just wait till the doctors start retiring .. en mass

36 16

I know someone who is basically working on a 'tricorder' type device for a certain large employer. So there is r&d being done to jump the techno gap.

ramble:

Most other things people have said are valid as well. My wife is an RN, and may jump fields if obama/pelosi/reid-care gets implemented.

A lot of her stories and grievances revolve around the tennat of people believing they have a right to get whatever the fuck they want while in hospital, and the doctors at her hospital say 'ok here ya go'.

Her hospital is also switching to E-charts, except they aren't providing the staff w/ tablet PCs so all it is doing is tripling their workload (as well as the system itself being crap). When she's on an e-chart floor her 12 hour day becomes at least 14.

The big thing with med school is the level at which we now expect doctors to be at. The more we expect doctors to know and do, the fewer there will be that can actually do it. There's a bit of a damned if you do, damned if you don't thing going on with that. RNs are already having their criteria lowered, and my wife says it shows. She's run into some RNs that graduated after she did that she wouldn't trust to put on a band-aid.

/ramble

37 I will say that if there is to be any gross increase in the supply of doctors (such that supply/demand demands lower salaries), med school costs will have to change somehow.

38 853,000 Practicing Doctors in America 1.4 Million Practicing Attorneys Reverse this number and you will solve high healthcare costs for 95% of all Americas. Its all about priorities. We'd rather get even, then get healthy.

39 tmi3rd,
You are spot on with your comments about the supply.  I think what we need are a vast increase in the number of medical schools.  jcp is right about the nature of the AMA being a guild limiting supply - that must stop.  I've always wondered why there can be 10 bazillion undergraduate schools but only a few dozen medical schools.

40 good ideas by smart folks here ... a bunch of morons could fix this if it wasn't really about unions, control, and politics.  ACORN shows that illegal alien/off the book activity is encouraged, and the middle class law abider will pay much higher rates, encouraging that poorer sector to remain in that warm and fuzzy dependence on the leftist state, as off the book annies and gardeners for our politicians.

On medical supply costs, we've seen reports on how much is overpaid in that arena.  I would have bought a better low air loss/alternating pressure bed, but had a more expensive bed Medicare provided, without the alternating pressure.  I was directed (by hospital staff) to a HilRom sales person that didn't seem to understand the purposes, but did understand the rules on what Medicare would pay for.  I don't know the financial relationships there, but I'd guess there are plenty of cozy ties that run up Medicare costs.

Doctors seem to be aligning with hospitals more in groups, since the burden of dealing with the paper work is so overwhelming for small offices.  Perhaps that is more efficient, or perhaps it shifts profit from the doctor to the "conglomerate".  In smaller towns, one hospital pretty much corners the market, and ancillary services are directed through their preferred providers.

So we direct people (though financial incentive) to get educated in business or law, doctors that provide the real, valuable service become subordinate.

41

I don't know what the answer to any of these questions is. All I know is that my personal physician is a 4'10", 90 lb, 40 y/o Philipina woman. And she has one of those sing-songy cadences when she speaks that have given sailors enormous erections for years.

I sometimes go see her just to get a B12 shot if ya know what I mean.

42

Jean @7, Brilliant approach to Malpractice problem as long as it is a private not a Government program.  Just get tort reform from feds for protection.  However that type system needs to apply to every level of reform.  Liability insurance at every level is too high.  The hospital has to insure the nurses, the drug manufacturer pays insurance, the hospital bed manufacturer pays liability insurance.  Tort not insurance reform is the larger key.

Placing light care facility just outside the ER for people with the sniffles.  Prior to sign in, a nurse sends Johnny with the sniffles out ef ER and to the clinic at a significantly lower price. If it escalates to something more serious, the clinic can send him back across the hall.

Large deductible policies for all.  Let the consumer pay the first $5000 of medical bills with MSA's accruing from the savings.  Even employer based plans.  The employer could reward the employee for rapid growth in his MSA.  Once the initial $5000 is accrued it should be able to be transfered to new employers and the employee should receive a percentage of the account over $5k payable either in cash or to 401K.  When the money is coming out of your pocket you spend a little more wisely.

Illegal immigrants should be treated and deported.

43 Does anyone notice the common thread among all these solutions?

It is to ether lessen or totally remove government interference in health care.

44

1. Have immigration enforcement officers do admittance in all emergency rooms.

2. Illeagals can get treatment and then get returned to their contry of origin.

3. SAVINGS!!!

45 As a practicing General Surgeon, I can suggest 3 things to start with: 1-Tort reform to lower the cost of malpractice insurance(85k/yr for myself) and to eliminate defensive medicine(I can cite several examples per week of unnecessary tests I order regularly to cover my ass) 2-Subsidize the cost of medical school. 3-Allow write offs on care delivered to the uninsured. That would fix the uninsured problem overnight. And add me to the list of retirees once Obamacare passes.......

46 #46

But the stiffy pill ads say to see your doctor if your have an erection lasting more than four hours. It's a vicious circle!

47 #48

Indeed. I'd go further and suggest that instead of trying to deliver health insurance to everyone, we should outlaw health insurance. It is an insane, broken concept.

Having insurance to cover non-catastrophic injury situations is like expecting your homeowner's policy to keep your refrigerator stocked and your car insurance to keep you tank full. It goes against what insurance is meant to do for the purchaser. It was only government interference that made insurance a common item in the first place, starting with wage controls under FDR, and then tax law in the 50s giving large businesses an advantage over new, small competitors.

I say get rid of it and let everything go back to a proper retail relationship. Expose what these function really cost and most healthy people will find they can afford to handle it on an as-needed basis.I recently read that much of the more developed portions of India operate this way. A common surgery like an appendectomy is offered for an amount many of us wouldn't hesitate to put on a credit card with a good rate. And the quality of care is claimed to be comparable to the US.

Eliminate the mass of insurance paperwork for the bulk of patients and you'll see a LOT of overhead costs simply disappear. This is how it works in a sane world. Can't we go there?

48 The University of Miami (Florida) had for 16 years a very successful 2 year Ph.D to MD program. It was eventually discontinued because the med school accreditation organization, i.e., the medical establishment, didn't like it. http://www6.miami.edu/UMH/CDA/UMH_Main/1,1770,2600-1;17585-3,00.html. The medical profession has many characteristics of a cartel (an arrangement to increase prices by limiting supply), e.g., the average incoming engineering class is 10x the size of the average incoming medical class. The organized medical profession (as opposed to individual doctors) does not want the supply of doctors increased. It will be very hard to change that. But some states have alternatives, such as physicians assistants or nurse practitioners who can do more or less what a doctor can, including write prescriptions. That appears to be the way to go. Also, in some foreign countries, many medicines that require a prescription here are sold over the counter in pharmacies.

49

I've been a providor in health care for 27 years. In all that time every doctor I know has been screaming for the same things but our voices have been overwhelmed by the PAC funds the insurance companies use to buy your congressmen. What *WE* know is that real health care has barely risen with the cost of taxes and inflation. Insurance companies on the other hand have posted double digit gains in profitability during the same period. At the same time there's been massive increases in liability litigation. Folks the lawyers and insurance companies have all convinced the public that there's massive fraud in health care as well. Fraud is like .o1% of the problem.

To lower costs you need three simple things and they DON'T involve Health Care Reform:

1)Tort reform with liability limits in litigation and loser pays rules. This alone would put an end to outragous Malpractice Premiums being passed on as the cost of doing business to paitents. Also capping punative damages JUST MAKES SENSE.

2) Interstate competition in the Health Insurance Industry combined with Federal Regulations regarding Insurance Administration, profitability and payments. The insurance industry is currently the poster child for corporate fraud and deception. Are you aware that the US Postal service works 99% of the time for everyone EXCEPT the insurance industry who will only receive a claim 83% of the time it's submitted?

3) Quit allowing politicians to regulate an industry they know nothing about. The myriad of laws health care providers have to observe daily are worse than the IRS tax code. In my field I have 7 different agencies watching over my shoulder to protect MY patients from ME and I'm in the top 3% of my field. 

OSHA was founded on Industrial Occupational Safety and has NO comprehension of infection control. That didn't keep them from defining penalties BEFORE they defined the "infection control" measures they thought I should conform to.

Let Health Care self regulate. Yes, incompetance and errors exist, but to compare that to the exhorbitant costs of politicians and lawyer insinuating themselves between the patient and the doctors, 99.999% of patients are better off taking their chances with the doctor!

50 http://www.youtube.com/watch?v=3E29LD98ruo

ReasonTV on free market health care.

51 As for constricting the numbers that get in med school ... when I was a chem major, there was intense competition amongst all the pre med gang , so they could get into med school.  It seems there are probably plenty willing and able .. or at least there were 35 years ago.

A group of profusionists I knew well, apparently were able to choose who got into their program.  It didn't seem to me honesty or intellect were necessarily preferred characteristics.  The guy selling the blood machines sponsored their sports teams and paid for parties, and they joked about the doc that always tried to contaminate some special $3000 device, even if not needed, so he could somehow profit from the "sale".  And one friend did offer to misplace my paperwork if I ever needed some work done.

There is so much corruption when the money seems to flow so "freely".  They are only stealing from government and insurance companies after all ... what is the harm?  Of course even the mafia is getting into Medicare fraud, which more "free care" will only encourage.

52 53 The University of Miami (Florida) had for 16 years a very successful 2 year Ph.D to MD program. It was eventually discontinued because the med school accreditation organization, i.e., the medical establishment, didn't like it.

http://www6.miami.edu/UMH/CDA/UMH_Main/1,1770,2600-1;17585-3,00.html.

The medical profession has many characteristics of a cartel (an arrangement to increase prices by limiting supply), e.g., the average incoming engineering class is 10x the size of the average incoming medical class. The organized medical profession (as opposed to individual doctors) does not want the supply of doctors increased.

I disagree with that theory entirely. I'm not a physican but neither physicians or dentists tend to think in terms of other physicians or dentists as being "their competition". In fact it's more a fraternity in the common fight against disease, pathology and ignorance. You will find at almost every Medical School, scholarship after scholarship underwritten and funded by those same professionals and their organzations, frequently in their patients names. That doesn't sound like any interest in class room limits to me.

53 1) Get rid of the medical liability lottery game. Significant Limits on non damage awards. This would allow many people to become general practitioners. Those people who quit being doctors in order to raise a family would be able to run their own clinics without fear that some lottery winning wannabee is going to come destroy their livelihood.
2) Deregulate heath care. As it stands you are either a total doctor or not a doctor. Entirely too many minor procedures require a person to have a full doctor to do. Why does someone need the training of a doctor to put in stitches?  If there was a between nurse and doctor level person who could do the minor procedures, more people would fit in the medical field. If you are smarter than what is needed to be a nurse, but not quite cut out to do surgeries, you end up going to another field of work, decreasing the number of health care providers.
3) Trash the employer paid for health insurance scam and have individuals be a part of their heath care spending planning. Many people will eventually see that catastrophic care insurance along with a health savings account would be in their best interests. This will cause people to shop around and look for effective low cost health care. This will create a market for smaller practices.

54 I've read that the obstacle to just adding seats in medical school is that there aren't enough residency slots, and you have to be a resident for two (?) years before you can be a full MD.  There are plenty of people who want to go to medical school.  So offer tax credits against the debt incurred for medical education for those doctors who go into primary care. (We have enough specialists).  Then offer subsidies to public hospitals to pay for additional primary-care intern and residency slots.  Sure, the quality of these additional physicians might not be as high as those who intern at private hospitals or who go into other specialties, but we desperately need more docs.

55 @Tushar,

Some of those foreign graduates are competent, but many of them are from awful medical schools that produce glorified PAs.

56 You could also adjust the EMTALA laws, which are the legal basis that for all practical purposes forces providers and hospitals to provide free ER care.

57 Can't tell if the thread is still going, but...

First of all, thanks for weighing in- spirited, as usual...

Anyway, nobody really gives a shit where you go to medical school- they give a shit a) where you did your residency, and b) did you or are you going to pass your boards?

At the emergency room where I work, we have three levels of emergency room- a treatment area where a PA handles things (stitches, burns, sniffles, and what not), a middle ground area where the genuinely sick or injured are seen by a physician, and a third area for the "oh, shit" cases.

As far as hospitals go- there was a remark earlier about how hospitals are in fact making money. That would be news to all my friends who are running hospitals in Dallas, Shreveport, New Orleans, Lake Charles, Baton Rouge, and Houston. I'm looking for articles that I can link to that either prove or disprove my point.

As far as medical schools go- my big thing is that I don't want to see standards lowered to increase admissions. I know enough marginally competent doctors as it is- I don't want to see more incompetent folks added to the roles.

For folks who aren't carrying a 3.75 or above, but instead have a solid 3.3-3.5 and a good MCAT score, there is the doctor of osteopathic medicine degree (DO), which is legally the same as an MD... there are fewer of those schools out there, but I know a bunch of very competent DOs who just didn't do as well in organic chem and physics as others.

Anyway, let's revisit this on bigger scales down the road- I've got finals in o-chem and biology this coming week, so I'll be a little busy. Once those wrap up, though, let's talk about the insurance side.