Just read the comments...

[TexasFight]

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http://www.nydailynews.com/ny_local...orth_shore_university_hospital_over_nosh.html

No doubt that these surgeons royally screwed up. But the comments here generalize and put down the profession like I've never seen before. 🙁

It's sounds like this isolated incident is uniting people against tort reform.

 

[Ableton]

The guy pulled in $7.2 million in a year... that's baller.

 

[bannie22]

the doctors were wrong. but some ppl realy are hating on doctors. maybe they shud go into med school themselves.

 

[Hoody]

The guy pulled in $7.2 million in a year... that's baller.

dude is 73. he's a super baller.

 

[schrizto]

I think it's stupid for the anesthesiologist to put the patient under if no one knows where the surgeon is. The neurosurgeon shouldn't have gone on his Florida vacation, but the whole situation could've been much less severe if the patient hadn't been anesthetized. Of course I am not too familiar with OR procedures and maybe it's common practice to put a patient under before the surgeon even shows up.

 

[DrYoda]

doctors aren't popular right now, you find anti-physician comments on the bottom of many healthcare articles.

 

[dw2158]

I think it's stupid for the anesthesiologist to put the patient under if no one knows where the surgeon is. The neurosurgeon shouldn't have gone on his Florida vacation, but the whole situation could've been much less severe if the patient hadn't been anesthetized. Of course I am not too familiar with OR procedures and maybe it's common practice to put a patient under before the surgeon even shows up.

no, the article says that the anesthesiologist did that in violation of hospital policy. i agree that that seems to be the main sticking point, even though everyone involved acted like @ssholes.

 

[austinap]

I just want to post a couple general comments about the whole "doctors aren't popular" thing. First off, I'm not saying that the distrust and dislike often seen in the public is completely deserved, but I think it's worth looking at. It seems that the general sentiment on SDN should be that doctors should automatically be respected because of how much school they've had to go through. That's a ridiculous argument. Doctors should be respected based on the quality of care that they deliver.

Look at things from the perspective of the average patient. They pay out the ass for insurance, and in return get almost no face time from their doctors, mis-communication between specialists, and generally frustrating care (care that is good on a technical level, but they're often left in the dark about what is going on). You can argue about what is more important, a doctor that is technically amazing but without time to 'waste' explaining everything to the patient, or a doctor who is technically mediocre but good at comforting the patient. I think most people here would say the former, but I'd be willing to bet that a good portion of patients would choose the latter if it were through experience. Hell, they don't know what's good anyways, but they do know when their doc doesn't have time for them.

There's also the perception of how doctors act and treat. With reimbursements decided based on the number of procedures performed, a lot of patients perceive doctors as doing as much as they can to get paid whether or not its really necessary. Again, you can argue if this is really the case, but it's the perception that matters.

And finally, the way the AMA has acted in the last ~30 years also makes physicians come off as being incredibly self-serving. The AMA has historically been against any kind of health care reform even when it has had strong public support. They've blocked numerous bills and have had some ridiculous advertisements against any kind of reform in the past. While I don't think it's as much of a problem anymore, there used to be cases of physicians being coerced into not supporting various flavors of reform. I think the public generally sees this as self-serving and directly in conflict with their best interests.

I think that the distrust in physicians (and scientists in general, if you want to get me started on another topic) is a real problem, but doctors themselves aren't completely without blame. Certainly, there are factors outside of physicians' control that they are blamed for nonetheless, but there are things that can be changed. I think the AMA should be more active in supporting physicians image and in helping physicians have a real voice in the inevitable change that will be coming. I think they're doing better than they have in the past, but we still have a ways to go.

 

[DrYoda]

^Having the president propagate the idea that doctors do all kinds on unnecessary things so they can make money doesn't help either.

 

[womp]

^ Having Kathleen Sebelius, the former director of the Kansas Trial Lawyers Association, in charge as the Health and Human Services Secretary doesn't help either.

 

[austinap]

^Having the president propagate the idea that doctors do all kinds on unnecessary things so they can make money doesn't help either.

First off, he's never blamed doctors for that but rather the incentives, and he's completely right. The AMA and the president of the Mayo clinic admit it as well.

Second, that would maybe be a valid argument if the distrust correlated with the new president. It doesn't. People have been frustrated with doctors for years, yet we've only had Obama in office for ~8 months.

 

[DrYoda]

First off, he's never blamed doctors for that but rather the incentives, and he's completely right. The AMA and the president of the Mayo clinic admit it as well.

It doesn't matter what his intent in saying it is. It's still is going to cause people to distrust physicians more.

Second, that would maybe be a valid argument if the distrust correlated with the new president. It doesn't. People have been frustrated with doctors for years, yet we've only had Obama in office for ~8 months.

The heathcare reform debate has brought out a lot of anti-physician setiment.

 

[austinap]

It doesn't matter what his intent in saying it is. It's still is going to cause people to distrust physicians more.

If having the system that pays you made public embarrasses you, then maybe we should work on changing the system that pays you.

The heathcare reform debate has brought out a lot of anti-physician setiment.

I actually disagree, especially in the last few weeks when more physicians have come out saying "look, we really do need some reform, let's not **** it up". Right now, I think most negative sentiment is directed at insurance companies and lobbyists.

 

[Substance P]

I just want to post a couple general comments about the whole "doctors aren't popular" thing. First off, I'm not saying that the distrust and dislike often seen in the public is completely deserved, but I think it's worth looking at. It seems that the general sentiment on SDN should be that doctors should automatically be respected because of how much school they've had to go through. That's a ridiculous argument. Doctors should be respected based on the quality of care that they deliver.

Look at things from the perspective of the average patient. They pay out the ass for insurance, and in return get almost no face time from their doctors, mis-communication between specialists, and generally frustrating care (care that is good on a technical level, but they're often left in the dark about what is going on). You can argue about what is more important, a doctor that is technically amazing but without time to 'waste' explaining everything to the patient, or a doctor who is technically mediocre but good at comforting the patient. I think most people here would say the former, but I'd be willing to bet that a good portion of patients would choose the latter if it were through experience. Hell, they don't know what's good anyways, but they do know when their doc doesn't have time for them.

There's also the perception of how doctors act and treat. With reimbursements decided based on the number of procedures performed, a lot of patients perceive doctors as doing as much as they can to get paid whether or not its really necessary. Again, you can argue if this is really the case, but it's the perception that matters.

And finally, the way the AMA has acted in the last ~30 years also makes physicians come off as being incredibly self-serving. The AMA has historically been against any kind of health care reform even when it has had strong public support. They've blocked numerous bills and have had some ridiculous advertisements against any kind of reform in the past. While I don't think it's as much of a problem anymore, there used to be cases of physicians being coerced into not supporting various flavors of reform. I think the public generally sees this as self-serving and directly in conflict with their best interests.

I think that the distrust in physicians (and scientists in general, if you want to get me started on another topic) is a real problem, but doctors themselves aren't completely without blame. Certainly, there are factors outside of physicians' control that they are blamed for nonetheless, but there are things that can be changed. I think the AMA should be more active in supporting physicians image and in helping physicians have a real voice in the inevitable change that will be coming. I think they're doing better than they have in the past, but we still have a ways to go.

Dude, there are sheisters in every profession. The problem is that the public is always looking for a scapegoat and the doctors are an easy target. They appear to make loads of money until you calculate malpractice, hours worked, and debt to income due to school loans, but the general public doesn't think about these things. They only see the gross dollars...

Btw, the AMA only represents about 1/3 of practicing physicians.

 

[DrYoda]

If having the system that pays you made public embarrasses you, then maybe we should work on changing the system that pays you.




I actually disagree, especially in the last few weeks when more physicians have come out saying "look, we really do need some reform, let's not **** it up". Right now, I think most negative sentiment is directed at insurance companies and lobbyists.

Did you actually read my comments?

 

[austinap]

Dude, there are sheisters in every profession. The problem is that the public is always looking for a scapegoat and the doctors are an easy target. They appear to make loads of money until you calculate malpractice, hours worked, and debt to income due to school loans, but the general public doesn't think about these things. They only see the gross dollars...

Btw, the AMA only represents about 1/3 of practicing physicians.

Sure, everyone is always looking for someone to blame. However, the medical profession hasn't exactly made themselves difficult targets either. I think there are a lot of things that could be improved.

As far as the AMA, you're right. That's not what the public sees though. They see it as the largest physician lobbying group in direct opposition to their best interests.

 

[austinap]

Did you actually read my comments?

And I just re-read them twice too. I'm admittedly short on sleep, what did I miss?

 

[mrmilad]

There is no fighting it. The comments are a reaction to a very stupid set of actions. You don't blame the people that are reacting to this, you blame doctors for pulling stupid antics like this and expecting to get away with it. Yes as a physician we want to be trusted, but we should not be wolves in sheep's clothing. We need to be the shepherds and behave appropriately and the sheep will follow.

 

[DrYoda]

And I just re-read them twice too. I'm admittedly short on sleep, what did I miss?

I also wasn't talking about physican support for healthcare reform (I think most people in general support some type of reform). I was saying the healthcare reform debate is bring out more bitterness directed at physicians from the public.

and the few bad apples like the doctors in that article aren't helping it.

 

[Substance P]

Sure, everyone is always looking for someone to blame. However, the medical profession hasn't exactly made themselves difficult targets either. I think there are a lot of things that could be improved.

As far as the AMA, you're right. That's not what the public sees though. They see it as the largest physician lobbying group in direct opposition to their best interests.

I don't think that anyone disagrees. Of course we need to change things, but the real question is what do we do...? That's the billion dollar question.

You should tell me what the medical profession can do to make themselves less of a target than they currently are, because if you know how to do that without changing the system or what the networks choose to report then you, my friend, should scrap medicine and go in PR.

People often oversimplify the problem we are facing. There is no easy solution, and the problem is that people from both sides only highlight the other sides weakness and their sides strengths. The vast majority of the people will fall somewhere in between, but they don't realize this. They are looking for a panacea or the proverbial magic bullet, and I hate to sound like a pessimist, but that doesn't exist.

 

[austinap]

There is no fighting it. The comments are a reaction to a very stupid set of actions. You don't blame the people that are reacting to this, you blame doctors for pulling stupid antics like this and expecting to get away with it. Yes as a physician we want to be trusted, but we should not be wolves in sheep's clothing. We need to be the shepherds and behave appropriately and the sheep will follow.

Yep. The amazing thing is that in order to make this story possible, two established physicians had to make completely idiotic decisions. I would like to see more accountability WITHIN the community instead of everyone screaming "we're the victim" whenever somebody else holds the doctors accountable.

 

[austinap]

I also wasn't talking about physican support for healthcare reform (I think most people in general support some type of reform). I was saying the healthcare reform debate is bring out more bitterness directed at physicians from the public.

and the few bad apples like the doctors in that article aren't helping it.

Yes, and my comment was that I actually don't think a lot of the bitterness in the public right now is aimed at doctors, but rather at insurance companies and their lobbyists BECAUSE a lot of doctors have come out to support reform. There is some, sure, but I don't think doctors are bearing the brunt of it.

 

[Substance P]

I also wasn't talking about physican support for healthcare reform (I think most people in general support some type of reform). I was saying the healthcare reform debate is bring out more bitterness directed at physicians from the public.

and the few bad apples like the doctors in that article aren't helping it.

This is exactly what the problem is. I also think that calling the healthcare proposals a debate is ridiculous, because hardly anyone understands what the hell they are actually proposing. It's more a debacle than a debate.

 

[womp]

First off, he's never blamed doctors for that but rather the incentives, and he's completely right. The AMA and the president of the Mayo clinic admit it as well.

Second, that would maybe be a valid argument if the distrust correlated with the new president. It doesn't. People have been frustrated with doctors for years, yet we've only had Obama in office for ~8 months.

If having the system that pays you made public embarrasses you, then maybe we should work on changing the system that pays you.

And who came up with this system? Medicare.

Look, Obama has been running around the country insinuating the worst of our physicians while cuddling to nurses. I've seen him photographed at 3-4 different nursing events since summer, peddling their "genuine dedication," hardwork and "patient-centered care." I love nurses too, I have several nurse relatives, but apparently doctors are just money-grubbers twiddling their thumbs all day:


Obama: "Nurses aren't in health care to get rich."

Obama: "When Sasha – our little precious pea – was just three months old, she was hospitalized with life-threatening meningitis….Very dangerous. The doctors did a terrific job, but frankly, it was the nurses that were there with us when she had to get a spinal tap, and all sorts of things that were just bringing me to tears. I'm biased toward nurses, I just like nurses."

Obama: "When both my daughters were born, the obstetrician was one of our best friends, but we saw her for about 10 minutes in each delivery. The rest of the time what we saw were nurses who did an incredible amount of work in not only taking care of Michelle but also caring for a nervous husband and then later for a couple of fat little babies."

President Obama, with nurses Becky Patton, left, and Linda Grual, made remarks on health insurance reform at the White House on Thursday.

Patton appears with President Obama to address the American Nurses Association

ABC News: "Obama Trots Out Nurses Endorsement (Again) to Keep Health Care Temperature Up"

 

[DrYoda]

Yes, and my comment was that I actually don't think a lot of the bitterness in the public right now is aimed at doctors, but rather at insurance companies and their lobbyists BECAUSE a lot of doctors have come out to support reform. There is some, sure, but I don't think doctors are bearing the brunt of it.

Ok, maybe I misunderstood then. Insurances companies are for sure disliked more than doctors (at least I hope so).

 

[Substance P]

Yes, and my comment was that I actually don't think a lot of the bitterness in the public right now is aimed at doctors, but rather at insurance companies and their lobbyists BECAUSE a lot of doctors have come out to support reform. There is some, sure, but I don't think doctors are bearing the brunt of it.

I think you're wrong. People think insurance companies charge the rates they do because doctors charge those exorbitant rates. They also believe doctors run extra tests to make more money, but don't realize that it's not a money making endeavor, but rather a CYA type of deal. If they don't run those tests and a patient dies or has a different diagnosis (regardless of how unlikely) the doctor can be faulted for negligence.

I hate to break it to you, but this how most people view the world...

 

[austinap]

I don't think that anyone disagrees. Of course we need to change things, but the real question is what do we do...? That's the billion dollar question.

You should tell me what the medical profession can do to make themselves less of a target than they currently are, because if you know how to do that without changing the system or what the networks choose to report then you, my friend, should scrap medicine and go in PR.

People often oversimplify the problem we are facing. There is no easy solution, and the problem is that people from both sides only highlight the other sides weakness and their sides strengths. The vast majority of the people will fall somewhere in between, but they don't realize this. They are looking for a panacea or the proverbial magic bullet, and I hate to sound like a pessimist, but that doesn't exist.

Well, I think the point is that there are certain things within the system that need to change. The AMA and the AHA admit that, and have identified at least a few specifics that they're in favor of.

As far as PR, I think there are a lot of things doctors, the AMA, and the AHA should be doing. They've decided on things that need to change, now I think they should be vocal about them. Since they're on the side of reform anyhow, they should let it be known. The AMA seems to support changing how doctors are reimbursed, and that's a major problem. It's restricting to doctors and a problem for patients.

This can definitely be spun as "as a doctor, I want whats best for my patients, but the current system doesn't embrace that in the best way. Change the system to allow me to be better." I don't even think that's disingenuous.

They could also be more vocal in discrediting propaganda that's being spread around. The 'death panel' craziness a month or two ago would have been a good starting point. I watched a panel discussion on Health Affairs a few weeks ago that was very eye opening on the subject of end of life care and what a living will actually does for you - but the public never gets to hear about that because we let people go spouting off crap that nobody bothers to disprove.

The president of the Mayo Clinic recently supported a public option so long as that option was realistic - the example he gave was something similar to the federal employees health benefits program. I think that's amazingly good PR, but most of the public won't hear that.

Doctors should be making it completely clear that they're on the side of the patients and that they want to change things, but we want to make sure we're changing the right things. Doctors should be leading health care reform, not sitting in back letting it happen and occasionally being victimized by it.

 

[DrYoda]

Doctors should be making it completely clear that they're on the side of the patients and that they want to change things, but we want to make sure we're changing the right things. Doctors should be leading health care reform, not sitting in back letting it happen and occasionally being victimized by it.

One thing I've found disappointing over the past 6 months is the lack of physician input on healthcare reform. I'm not quite sure what the reason for it is, but it is disturbing that the actual healthcare providers are largely out of the loop.

 

[austinap]

I think you're wrong. People think insurance companies charge the rates they do because doctors charge those exorbitant rates. They also believe doctors run extra tests to make more money, but don't realize that it's not a money making endeavor, but rather a CYA type of deal. If they don't run those tests and a patient dies or has a different diagnosis (regardless of how unlikely) the doctor can be faulted for negligence.

I hate to break it to you, but this how most people view the world...

I think rates are a part of it, but I think there's more bitterness and distrust towards the insurance companies for randomly dropping customers when they need care most, not covering customers due to irrelevant pre-existing conditions, etc.

As far as the running more tests, I agree, it's mostly a CYA thing. But if you're sure that doctors don't run any more tests or make decisions because they think they'll get paid more, then why don't we remove that incentive from our system entirely just to remove all doubt? Regardless of the outcomes, the current reimbursement system often introduces a conflict of interest that simply shouldn't be there.

 

[Substance P]

I think rates are a part of it, but I think there's more bitterness and distrust towards the insurance companies for randomly dropping customers when they need care most, not covering customers due to irrelevant pre-existing conditions, etc.

As far as the running more tests, I agree, it's mostly a CYA thing. But if you're sure that doctors don't run any more tests or make decisions because they think they'll get paid more, then why don't we remove that incentive from our system entirely just to remove all doubt? Regardless of the outcomes, the current reimbursement system often introduces a conflict of interest that simply shouldn't be there.

I think there has been a large shift in focus from insurance companies to doctors. It's ridiculous. While doctors should be more vocal in the debate, many just simply don't have the time to do the research necessary and to take a stand, or they just don't know how.

I hope you're aware that you are advancing into a career with some of the most socially inept people on the planet, barring engineers and research PhD's. So, it's not really surprising to me that many aren't getting involved. It is a shame though.

As far as the system changes you are proposing I don't really like the idea of making services "free." I'm a capitalist through and through and believe the only solution to this problem is to put the financial decisions back into the customers hand (patients) and the vendors (doctors). Outside of that, insurance companies should be in place for catastrophic events. Nothing more. I just don't want to see people lose everything due to an illness or injury.

 

[austinap]

I think there has been a large shift in focus from insurance companies to doctors. It's ridiculous. While doctors should be more vocal in the debate, many just simply don't have the time to do the research necessary and to take a stand, or they just don't know how.

I hope you're aware that you are advancing into a career with some of the most socially inept people on the planet, barring engineers and research PhD's. So, it's not really surprising to me that many aren't getting involved. It is a shame though.

As far as the system changes you are proposing I don't really like the idea of making services "free." I'm a capitalist through and through and believe the only solution to this problem is to put the financial decisions back into the customers hand (patients) and the vendors (doctors). Outside of that, insurance companies should be in place for catastrophic events. Nothing more. I just don't want to see people lose everything due to an illness or injury.

I think you let a lot of your naivety show here. First, with your categorization of peoples social skills. The engineering stereotype has some bit of truth to it, though one of my most social friends did his undergraduate degree in engineering. My experience with doctors puts them towards the upper end of the 'how social are you' spectrum. Pre-meds, maybe not, but dealing with patients every day makes for a lot of practice. Research scientists too - while graduate school definitely attracts some odd people, there are also some incredibly social scientists I know. Public speaking, interacting with peers extensively, etc all make for a lot of opportunities to practice.

I now have a question for you as a 'capitalist': what does paying doctors by the procedure incentivize doctors to do?

Do you consider doctors to be the one group that doesn't respond to market forces?

 

[Substance P]

I think you let a lot of your naivety show here. First, with your categorization of peoples social skills. The engineering stereotype has some bit of truth to it, though one of my most social friends did his undergraduate degree in engineering. My experience with doctors puts them towards the upper end of the 'how social are you' spectrum. Pre-meds, maybe not, but dealing with patients every day makes for a lot of practice. Research scientists too - while graduate school definitely attracts some odd people, there are also some incredibly social scientists I know. Public speaking, interacting with peers extensively, etc all make for a lot of opportunities to practice.

In response to your first part, that is anecdotal. I've outlined a few possible reasons for the lack of physician support, only one of them being the socially inept factor. I hate to break it to you though, if you are expecting to be paired with a group of social dynamos in med school, residency, and practice then you have been misinformed. Some docs are great and some specialties draw more of the outgoing docs and some draw more of the introverted odd types, but overall the message is the same, quite a few docs are socially awkward.

In response to your questions:

I now have a question for you as a 'capitalist': what does paying doctors by the procedure incentivize doctors to do?

The patient controls the dollars and competition will drive prices down. The patient will have the option of shopping around for better rates and will also drive the price of commonly required procedures or labs way down. Doctors are going to need to stay competitive or they will lose business. This will be a self-regulatory mechanism. Sure, some will try to tack on "extras," but it could come back to haunt them for bad business practices.

Do you consider doctors to be the one group that doesn't respond to market forces?

Absolutely not.

 

[Desaad]

First off, he's never blamed doctors for that but rather the incentives, and he's completely right. The AMA and the president of the Mayo clinic admit it as well.

Second, that would maybe be a valid argument if the distrust correlated with the new president. It doesn't. People have been frustrated with doctors for years, yet we've only had Obama in office for ~8 months.

Here here!

Well said, and an excellent argument. Doctors aren't the whole problem, but certainly a lot of them are PART of the problem.

 

[austinap]

The patient controls the dollars and competition will drive prices down. The patient will have the option of shopping around for better rates and will also drive the price of commonly required procedures or labs way down. Doctors are going to need to stay competitive or they will lose business. This will be a self-regulatory mechanism. Sure, some will try to tack on "extras," but it could come back to haunt them for bad business practices.

There are a few problems I see with the entirely market-driven health care idea:

1. It relies on informed consumers - e.g., the consumer knows the difference between choices and is able to determine when they do and do not need something. You're going to have a hard time convincing me that this is a reasonable assumption for health care.

2. It over corrects in the other direction - instead of consumers getting too much care, it would incentivize them to under-medicate. This seems to me to be directly conflicting with any sort of preventative medicine, especially if you add in a high-ticket item insurance plan. You'd then have a similar system to what we have now with the uninsured and emergency visits: people will avoid paying for routine care, letting problems get to the point where the insurance would then kick in to pay part.

3. Expensive procedures, ones that would presumably be covered under your catastrophic insurance scheme, make up a large portion of health care costs in this country. Your scheme does nothing to reduce the cost of those procedures.

4. It doesn't scale well to emergency situations. While it may reduce non-emergency visits to the ED, people who are going to the ER anyhow usually aren't in a rational state of mind. There are two cases here: your strategy doesn't work, or it has negative consequences. The first case is that everyone just goes to the closest ER anyhow, so there really is no competition. The second (and worse) case is that people go out of their way to go to a more distant ER, leading to worse outcomes for almost all emergency conditions.

In addition, since you still have a high ticket item insurance plan, the administrative overhead in our current system would still remain. I'm not convinced.

 

[womp]

There are a few problems I see with the entirely market-driven health care idea:

Why are most essential medical equipment today so expensive and never discounted?

Lasik used to be $4000-5000 per eye in 1998, how come it's now around $1000? Shouldn't it be $6000 an eye today adjusted for inflation? Is it because costs have gone down? How is it that Lasik equipment has gone down in price so much and so quickly?

How much does 4gb of DDR2 Ram cost today versus 4 years ago?

 

[austinap]

Why are most essential medical equipment today so expensive and never discounted?

Lasik used to be $4000-5000 per eye in 1998, how come it's now around $1000? Shouldn't it be $6000 an eye today adjusted for inflation? Is it because costs have gone down? How is it that Lasik equipment has gone down in price so much and so quickly?

How much does 4gb of DDR2 Ram cost today versus 4 years ago?

I completely agree with having an open market with no restrictions whatsoever for elective procedures. That doesn't address the problems with having an open market for required care.

 

[Blesbok]

"severe and serious personal injuries, a shock to her nervous system, physical pain and mental anguish"

Really? Seriously? Maybe you should consider the personal injury those extra donuts every morning are doing to your body before bitching about a little anesthesia.

Yes, the anesthesiologist was wrong to put the patient under without a surgeon around, but seriously, this is why healthcare in america costs so much, because people think they deserve something for nothing. Tell you what, do her surgery for free and call it a day.

Although on the flip side, the chiari foundation operates on so much bull**** it is ridiculous. They need a slap in the face.
​

 

[Substance P]

There are a few problems I see with the entirely market-driven health care idea:

1. It relies on informed consumers - e.g., the consumer knows the difference between choices and is able to determine when they do and do not need something. You're going to have a hard time convincing me that this is a reasonable assumption for health care.

2. It over corrects in the other direction - instead of consumers getting too much care, it would incentivize them to under-medicate. This seems to me to be directly conflicting with any sort of preventative medicine, especially if you add in a high-ticket item insurance plan. You'd then have a similar system to what we have now with the uninsured and emergency visits: people will avoid paying for routine care, letting problems get to the point where the insurance would then kick in to pay part.

3. Expensive procedures, ones that would presumably be covered under your catastrophic insurance scheme, make up a large portion of health care costs in this country. Your scheme does nothing to reduce the cost of those procedures.

4. It doesn't scale well to emergency situations. While it may reduce non-emergency visits to the ED, people who are going to the ER anyhow usually aren't in a rational state of mind. There are two cases here: your strategy doesn't work, or it has negative consequences. The first case is that everyone just goes to the closest ER anyhow, so there really is no competition. The second (and worse) case is that people go out of their way to go to a more distant ER, leading to worse outcomes for almost all emergency conditions.

In addition, since you still have a high ticket item insurance plan, the administrative overhead in our current system would still remain. I'm not convinced.

1) This is the patients responsibility. Nobody other than the patient can tell them how they feel or if they have something wrong. I feel no pity for those who don't take their health into their own hands.

2) Are you so sure about that? If preventative medicine is touted or advertised to patients, they will seek it out. Think an oil change for your car. People don't understand what happens when the car doesn't get an oil change, but they know it will cost them a lot more to wait until it breaks down to fix it than it would to do a little routine maintenance. The body is the same thing. These preventative services will be dirt cheap in a free market medical model, because people would seek them out regularly.

3) Catastrophic care ONLY would drastically reduce premiums. No ifs ands or buts about it. Once again, think car insurance. If your car insurance covered your oil changes, flat tires, tune-ups, and every little thing that went wrong with your vehicle the cost to cover your car would be outrageous, just like medical insurance. Now you would have the option to buy a plan that could cover more, but it would be in your best interests to barter directly with your doc for regular care. The high cost intensive procedures would still be costly, yes, but then again so is totaling your car and trying to have it repaired. Some procedures by there very nature will still be expensive, but it will be in both the patients and the insurance companies best interests to get lower rates and will most likely be shopped by both, unless the patient is incapacitated.

4) ED visits come out of your pocket. It scales. Most ED visits are non-urgent care visits, they are merely visits out of convenience so that individuals don't have to miss work to see a PCP. Under a free market health care plan, it would incent PCP's to be open at night to 'capture' that ED visit. Sure it might be more expensive than a day visit, but the prices also might be driven down by night owl physicians or those trying to gain a new client base.

I think you are missing the idea of a capitalistic model. I have yet to see a historical example of where capitalism has failed. Now I have in turn seen an example for every other type of system failing, think socialism, communism, etc. via integration of government into the private sector. Right now we are balancing on a fulcrum of change, and the real question is are we going to take the easy way out and let the government run it for us or are we going to take our health care into our own hands and run it for ourselves. I know where my interests lie, but do you know where the governments are?

I completely agree with having an open market with no restrictions whatsoever for elective procedures. That doesn't address the problems with having an open market for required care.

I think the problem is that you aren't seeing the overlap. I agree with the above poster. The market will drive prices down.

 

[FuturaDocta]

President Obama, with nurses Becky Patton, left, and Linda Grual, made remarks on health insurance reform at the White House on Thursday.
[/QUOTE]

Dang, those nurses in the back need to reform their own health care. They look like they want to gobble him up once no one's wathcing.

 

[Blesbok]

I think you're wrong. People think insurance companies charge the rates they do because doctors charge those exorbitant rates. They also believe doctors run extra tests to make more money, but don't realize that it's not a money making endeavor, but rather a CYA type of deal. If they don't run those tests and a patient dies or has a different diagnosis (regardless of how unlikely) the doctor can be faulted for negligence.

I hate to break it to you, but this how most people view the world...

Contrary to popular belief, ostriches do not bury their heads in sand.[27] This myth likely began with Pliny the Elder (A.D. 23-79), who wrote that ostriches "imagine, when they have thrust their head and neck into a bush, that the whole of their body is concealed."[28]

 

[Blesbok]

And who came up with this system? Medicare.

Look, Obama has been running around the country insinuating the worst of our physicians while cuddling to nurses. I've seen him photographed at 3-4 different nursing events since summer, peddling their "genuine dedication," hardwork and "patient-centered care." I love nurses too, I have several nurse relatives, but apparently doctors are just money-grubbers twiddling their thumbs all day:


Obama: "Nurses aren't in health care to get rich."

Obama: “When Sasha – our little precious pea – was just three months old, she was hospitalized with life-threatening meningitis….Very dangerous. The doctors did a terrific job, but frankly, it was the nurses that were there with us when she had to get a spinal tap, and all sorts of things that were just bringing me to tears. I’m biased toward nurses, I just like nurses.”

Obama: "When both my daughters were born, the obstetrician was one of our best friends, but we saw her for about 10 minutes in each delivery. The rest of the time what we saw were nurses who did an incredible amount of work in not only taking care of Michelle but also caring for a nervous husband and then later for a couple of fat little babies."



President Obama, with nurses Becky Patton, left, and Linda Grual, made remarks on health insurance reform at the White House on Thursday.


Patton appears with President Obama to address the American Nurses Association

ABC News: "Obama Trots Out Nurses Endorsement (Again) to Keep Health Care Temperature Up"

Yes, but who did the spinal tap?

And believe it or not, the reason doctors dont spend hours with you after your child is born is because there are actually other families birthing children also. I know it is hard to believe, but true.

I hate people that write stupid ass speeches designed to persuade stupid ass people.

 

[Blesbok]

And also, last time I checked, there are not too many professions that anyone can get into, go to school for 2 years after high school, and make $50-75k /yr. Nurses aren't exactly doing their work for peanuts.

 

[Substance P]

Contrary to popular belief, ostriches do not bury their heads in sand.[27] This myth likely began with Pliny the Elder (A.D. 23-79), who wrote that ostriches "imagine, when they have thrust their head and neck into a bush, that the whole of their body is concealed."[28]

True, but that wasn't the point. 😉

 

[Substance P]

And also, last time I checked, there are not too many professions that anyone can get into, go to school for 2 years after high school, and make $50-75k /yr. Nurses aren't exactly doing their work for peanuts.

If not more!!! That is the thing that really pisses me off about people saying docs have it so much better than nurses. Docs are directly responsible if something bad happens to the pt, they have to pay for malpractice insurance, work long hours, and do endless amounts of paperwork. Nurses on the other hand get to spend a lot more time with the pts, make a ton of money for the education, and only work 36 hours a week!!!

In dollars per hour and after expenses, nurses aren't averaging much less than docs.

 

[Spiker]

LOL this is the SECOND time I read about those two fk things up!

 

[austinap]

1) This is the patients responsibility. Nobody other than the patient can tell them how they feel or if they have something wrong. I feel no pity for those who don't take their health into their own hands.

That is a completely unreasonable demand on consumers. Take for example an arthritis patient given the choice between two anti-inflammatory drugs, ibuprofen and a second, considerably more expensive drug without the GI side effects. Is that consumer now supposed to evaluate their own risk factor for the GI problems? Furthermore, how can you expect them to estimate what the cost will be if they do turn up with complications?

This little excerpt is particularly inane:

Nobody other than the patient can tell them...if they have something wrong.

WTF do you think modern medicine does then?

2) Are you so sure about that? If preventative medicine is touted or advertised to patients, they will seek it out. Think an oil change for your car. People don't understand what happens when the car doesn't get an oil change, but they know it will cost them a lot more to wait until it breaks down to fix it than it would to do a little routine maintenance. The body is the same thing. These preventative services will be dirt cheap in a free market medical model, because people would seek them out regularly.

Yeah, I'm pretty sure that a significant number of people would forgo preventative treatment because of the out of pocket cost. I know more than enough people that don't get regular checkups on their car, don't fix their brakes, etc, because _that_ is too expensive. Is it smart? No. But that's how it is.

3) Catastrophic care ONLY would drastically reduce premiums. No ifs ands or buts about it. Once again, think car insurance. If your car insurance covered your oil changes, flat tires, tune-ups, and every little thing that went wrong with your vehicle the cost to cover your car would be outrageous, just like medical insurance. Now you would have the option to buy a plan that could cover more, but it would be in your best interests to barter directly with your doc for regular care. The high cost intensive procedures would still be costly, yes, but then again so is totaling your car and trying to have it repaired. Some procedures by there very nature will still be expensive, but it will be in both the patients and the insurance companies best interests to get lower rates and will most likely be shopped by both, unless the patient is incapacitated.

Yeah, it would reduce premiums because not as much would be covered. It's just rearranging the costs - now instead of paying all that money for insurance alone, they pay somewhat less for insurance but make up the difference in out of pocket expenses.

4) ED visits come out of your pocket. It scales. Most ED visits are non-urgent care visits, they are merely visits out of convenience so that individuals don't have to miss work to see a PCP. Under a free market health care plan, it would incent PCP's to be open at night to 'capture' that ED visit. Sure it might be more expensive than a day visit, but the prices also might be driven down by night owl physicians or those trying to gain a new client base.

Unless I'm misreading you, you're suggesting that we get rid of obligatory emergency care. That would be a great idea! Now we can just let people bleed to death in the waiting room while we explain to the family that they have to pay out of pocket. Way to send the US medical system back to the stone age.

I think you are missing the idea of a capitalistic model. I have yet to see a historical example of where capitalism has failed. Now I have in turn seen an example for every other type of system failing, think socialism, communism, etc. via integration of government into the private sector. Right now we are balancing on a fulcrum of change, and the real question is are we going to take the easy way out and let the government run it for us or are we going to take our health care into our own hands and run it for ourselves. I know where my interests lie, but do you know where the governments are?

I think you need to define failure here. I'm not arguing at all that you couldn't use market forces to drive down costs. I'm arguing that the side effects of such a system would be ridiculous, your out of pocket ER visits among them.

If you want to see a failure of capitalism to meet good results, just look at the world environment. First world economies have incentivized exploiting the developing world for minerals, labor, and essentially every other natural resource.

If you're looking for general examples of capitalism to fail to even meet its own goals, look into examples of market failure. The sub-prime mortgage fiasco from the last few years is a good example.

I think the problem is that you aren't seeing the overlap. I agree with the above poster. The market will drive prices down.

Again, I'm not arguing that you couldn't drive down costs, I'm arguing that the side effects are unreasonably severe for something like basic health care.

 

[Substance P]

That is a completely unreasonable demand on consumers. Take for example an arthritis patient given the choice between two anti-inflammatory drugs, ibuprofen and a second, considerably more expensive drug without the GI side effects. Is that consumer now supposed to evaluate their own risk factor for the GI problems? Furthermore, how can you expect them to estimate what the cost will be if they do turn up with complications?

This little excerpt is particularly inane:



WTF do you think modern medicine does then?




Yeah, I'm pretty sure that a significant number of people would forgo preventative treatment because of the out of pocket cost. I know more than enough people that don't get regular checkups on their car, don't fix their brakes, etc, because _that_ is too expensive. Is it smart? No. But that's how it is.



Yeah, it would reduce premiums because not as much would be covered. It's just rearranging the costs - now instead of paying all that money for insurance alone, they pay somewhat less for insurance but make up the difference in out of pocket expenses.



Unless I'm misreading you, you're suggesting that we get rid of obligatory emergency care. That would be a great idea! Now we can just let people bleed to death in the waiting room while we explain to the family that they have to pay out of pocket. Way to send the US medical system back to the stone age.



I think you need to define failure here. I'm not arguing at all that you couldn't use market forces to drive down costs. I'm arguing that the side effects of such a system would be ridiculous, your out of pocket ER visits among them.

If you want to see a failure of capitalism to meet good results, just look at the world environment. First world economies have incentivized exploiting the developing world for minerals, labor, and essentially every other natural resource.

If you're looking for general examples of capitalism to fail to even meet its own goals, look into examples of market failure. The sub-prime mortgage fiasco from the last few years is a good example.




Again, I'm not arguing that you couldn't drive down costs, I'm arguing that the side effects are unreasonably severe for something like basic health care.

I think the problem is that you're a liberal idealist. Not in itself a bad thing, but people like you (not meant as an insult) breed stagnation. You have yet to add any insight as to how you would suggest a change, nor have you properly derailed any of mine. You are also seeming to have a difficult time defining success. Success doesn't mean it will make the world a drastically different place and we'll all live a peachy keen existence with perfect medical coverage, it simply means it would be an improvement. Would this method leave people without care? Yes. Would Obamas and/or the plan you have yet to propose? Yes.

By the way, you misunderstood quite a few of my statements. You should go back and read them with some common sense and assume others have the same and see if the meanings change at all for you. 😉

 

[austinap]

I think the problem is that you're a liberal idealist. Not in itself a bad thing, but people like you (not meant as an insult) breed stagnation. You have yet to add any insight as to how you would suggest a change, nor have you properly derailed any of mine. You are also seeming to have a difficult time defining success. Success doesn't mean it will make the world a drastically different place and we'll all live a peachy keen existence with perfect medical coverage, it simply means it would be an improvement. Would this method leave people without care? Yes. Would Obamas and/or the plan you have yet to propose? Yes.

By the way, you misunderstood quite a few of my statements. You should go back and read them with some common sense and assume others have the same and see if the meanings change at all for you. 😉

No, I think the problem is that you're a free market idealist. You've defined success so narrowly that it ignores any factors outside of cost.

I haven't included my own strategies since this wasn't mean to be a "what's the best health care reform strategy?" discussion, I was simply responding to a few blanket statements you made. We can have that discussion if you'd like.

Here's the problem I have with capitalist and libertarian idealists. Whenever your system breaks down, you just step in and point the finger and say its because somebody else messed up your perfect plan. Capitalism causes people to do ridiculously selfish things and **** up (pick any of: the environment, the banking system, the US economy, etc) and your response is "deregulation! We can't work under these constraints!"

You're also treating 'badness' in our medical system as a binary thing: it's either there or it isn't. Again, completely ridiculous because EVERY system will have something wrong with it. The question is "which is the least bad?"

If you want to have a real discussion about this, let's start from the beginning. What is your definition of success?

 

[Substance P]

No, I think the problem is that you're a free market idealist. You've defined success so narrowly that it ignores any factors outside of cost.

I haven't included my own strategies since this wasn't mean to be a "what's the best health care reform strategy?" discussion, I was simply responding to a few blanket statements you made. We can have that discussion if you'd like.

Here's the problem I have with capitalist and libertarian idealists. Whenever your system breaks down, you just step in and point the finger and say its because somebody else messed up your perfect plan. Capitalism causes people to do ridiculously selfish things and **** up (pick any of: the environment, the banking system, the US economy, etc) and your response is "deregulation! We can't work under these constraints!"

You're also treating 'badness' in our medical system as a binary thing: it's either there or it isn't. Again, completely ridiculous because EVERY system will have something wrong with it. The question is "which is the least bad?"

If you want to have a real discussion about this, let's start from the beginning. What is your definition of success?

Aye yei yei... Seriously? Capitalism is one of the primary forces behind innovation and your environmentalist/banking/economy statements don't hold up. If you honestly believe we live in a purely capiatalistic society within the US, you have been very deluded. The very nature of capitalism would predict success and failure, everyone can't be a success. I'm not sure how people keep throwing these banking fiascos out as any sort of 'proof' that capitalism doesn't work. If you get rid of the billions of dollars of governement aid and allow these banks to sink or swim we would be talking. Environment? I'm guessing that you're the same guy who complains about the gas prices while you fill up your tank, then later goes on to complain about oil drilling and tapping the oil reserves. You can't have your cake and eat it too...

I would love to cary on this discussion, but realistically it won't go anywhere because of an innate difference in our baseline ideals. If you want, I would be happy to entertain your ideas on health care reform via PM or you can post them here, but we are derailing this thread big time.

 

[austinap]

Aye yei yei... Seriously? Capitalism is one of the primary forces behind innovation and your environmentalist/banking/economy statements don't hold up. If you honestly believe we live in a purely capiatalistic society within the US, you have been very deluded. The very nature of capitalism would predict success and failure, everyone can't be a success. I'm not sure how people keep throwing these banking fiascos out as any sort of 'proof' that capitalism doesn't work. If you get rid of the billions of dollars of governement aid and allow these banks to sink or swim we would be talking. Environment? I'm guessing that you're the same guy who complains about the gas prices while you fill up your tank, then later goes on to complain about oil drilling and tapping the oil reserves. You can't have your cake and eat it too...

I would love to cary on this discussion, but realistically it won't go anywhere because of an innate difference in our baseline ideals. If you want, I would be happy to entertain your ideas on health care reform via PM or you can post them here, but we are derailing this thread big time.

Yeah, the bail out was decidedly not capitalistic, but the subprime mortgage fiasco that set it off was. I'd like more explanation on how the environmental examples don't hold up. Seriously. I'd like details there, because that seems to me to be the biggest failure of capitalism in the last century.

For the record, I don't have a car, and I think gas prices should be significantly higher than they are. I'm really not that big of a hippy, but it's hard to deny that capitalism hasn't been disastrous for the environment in the developing world.

Here again is my primary objection to using a purely market-based approach towards health care:

The very nature of capitalism would predict success and failure, everyone can't be a success.

A truer statement has never been spoken. I just think that basic medical care is a fundamental responsibility of a democratic society, and that a capitalistic approach creates an unacceptable number of losers.


Here's a brief list of a few goals I think are important for health care reform in this country, in order of importance.

1. Everybody has access to some fundamental medical care, including emergency care, regardless of their financial status.
2. Medical coverage should not be linked to employment, and once insured, you should not be able to lose your coverage based on your current health.
3. Total cost of health care in this country needs to be stabilized. This probably comes from a number of fronts, but encouraging preventative care should be one aspect to this.

I think the 'fundamental benefits' should be defined on the federal level. Even more, though this is a bit federalist, I think that insurance company regulations should be done primarily at the federal level the encourage wider competition between health insurance agencies. Creating a health insurance exchange, similar to what the federal employees health benefits program does, would do a lot towards these goals.

There are other aspects of tax reform that should go into this as well. Right now, because employer health benefits are tax deductible, health insurance is already heavily subsidized in this country, only it's done a bit backwards. Because of tax brackets, the wealthy pay a lower marginal rate for their health insurance than do the poor. I think it makes sense to modify this to some extent.

Your free market approach obviously addresses the third of my goals, but I don't see how it reasonably takes care of the first two. If I'm just completely blind, so be it, but please inform me rather than just saying I'm wrong.


In addition to financial reform, I think there are things that should actually be done to reform medical care in this country, rather than just medical coverage. There are gross inefficiencies in the system that should be address, and I think physician incentives need to be changed.