Sellouts: Once Its Greatest Foes, Doctors Are Embracing Single-Payer

[drusso]

Remarks on State Healthcare Innovation

"As we undertake our efforts to free up competition from the federal level, we hope all of you will examine what can be done in the states. Delivering free markets in American healthcare is an ambitious goal. But I can tell you, the exciting thing about working for President Trump is that ideas and goals that some might dismiss as too ambitious are welcomed—even expected."

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[Ducttape]

DPC is a nice niche market, just like concierge medicine, but it seems very unlikely to provide sufficient traction in the long term.

there is no catastrophic component to DPC. hospital charges, which make up the bulk of what it costs the healthcare system, are not included in a DPC system.... unless it is paired with - a catastrophic health insurance plan. ie there goes a lot of the perceived savings.

DPC plans would not work for Medicaid patients, or many of those enrolled in medicare, unless that money were directly routed to a DPC. so roughly 49% of the population would not be able to access a DPC.


I agree, having the option of a DPC would be nice for patients - who have expendable money to be able to access such a plan.....

 

[VA Hopeful Dr]

DPC is a nice niche market, just like concierge medicine, but it seems very unlikely to provide sufficient traction in the long term.

there is no catastrophic component to DPC. hospital charges, which make up the bulk of what it costs the healthcare system, are not included in a DPC system.... unless it is paired with - a catastrophic health insurance plan. ie there goes a lot of the perceived savings.

DPC plans would not work for Medicaid patients, or many of those enrolled in medicare, unless that money were directly routed to a DPC. so roughly 49% of the population would not be able to access a DPC.


I agree, having the option of a DPC would be nice for patients - who have expendable money to be able to access such a plan.....

You don't seem to get it. Its not about fixing the entire system which no single thing can do, its about fixing what can be fixed without major issues. In this case, its saving money. And its not necessarily for everyone, though it certainly is scalable to a degree.

The major advantage to DPC on a large scale is using it with a health plan designed specifically to do so like. That's why all the big money savings we see is a result of employers paying for DPC for their employees/dependents. If you can realize significant savings from primary care, it certainly won't fix healthcare as a whole but every bit of savings matters. Best I can find, primary care accounts for 10% of total health care spending. DPC generally saves about 20% on costs. So that's 2% savings on total health care expenditure. That's pretty big. Now obviously that assumes total penetration of the model which is unlikely. But let's say we can save 1% of that 2%. That's 0.02% of over 3 trillion dollars.

This also applies to cash-only surgery, like the Oklahoma article I linked. There aren't as many figures on this yet because its a newer pairing, but it looks very promising. There is massive potential there. Think about it: a knee replacement at most hospitals averages 50k. Free market places are between 15-20k. So we're talking at least 30k in savings per knee. There are roughly 700,000 knee replacements/year in the US. Let's be generous and say that only a 10% of those are healthy enough patients for a surgery center. That's still a $2 billion dollar savings. From just 10% of a single procedure.

There was a large DPC group in Washington State that partnered with Medicaid exactly as you described. Last I heard was that they cut primary care costs for Medicaid by around 18%. That won't save all of healthcare, but it certainly helps.

 

[drusso]

DPC is a nice niche market, just like concierge medicine, but it seems very unlikely to provide sufficient traction in the long term.

there is no catastrophic component to DPC. hospital charges, which make up the bulk of what it costs the healthcare system, are not included in a DPC system.... unless it is paired with - a catastrophic health insurance plan. ie there goes a lot of the perceived savings.

DPC plans would not work for Medicaid patients, or many of those enrolled in medicare, unless that money were directly routed to a DPC. so roughly 49% of the population would not be able to access a DPC.


I agree, having the option of a DPC would be nice for patients - who have expendable money to be able to access such a plan.....

DPC can be combined with subsidized catastrophic plans and HSA's. You can even set up group purchasing & reinsurance arrangements to pay for PRP injections for Medicaid patients...

 

[VA Hopeful Dr]

DPC can be combined with subsidized catastrophic plans and HSA's. You can even set up group purchasing & reinsurance arrangements to pay for PRP injections for Medicaid patients...

Or do what lots of places do and offer traditional insurance plans OR a DPC option that covers everything at lower deductibles/co pays.

Still been shown to save money.

 

[hyperalgesia]

You don't seem to get it. Its not about fixing the entire system which no single thing can do, its about fixing what can be fixed without major issues. In this case, its saving money. And its not necessarily for everyone, though it certainly is scalable to a degree.

The major advantage to DPC on a large scale is using it with a health plan designed specifically to do so like. That's why all the big money savings we see is a result of employers paying for DPC for their employees/dependents. If you can realize significant savings from primary care, it certainly won't fix healthcare as a whole but every bit of savings matters. Best I can find, primary care accounts for 10% of total health care spending. DPC generally saves about 20% on costs. So that's 2% savings on total health care expenditure. That's pretty big. Now obviously that assumes total penetration of the model which is unlikely. But let's say we can save 1% of that 2%. That's 0.02% of over 3 trillion dollars.

This also applies to cash-only surgery, like the Oklahoma article I linked. There aren't as many figures on this yet because its a newer pairing, but it looks very promising. There is massive potential there. Think about it: a knee replacement at most hospitals averages 50k. Free market places are between 15-20k. So we're talking at least 30k in savings per knee. There are roughly 700,000 knee replacements/year in the US. Let's be generous and say that only a 10% of those are healthy enough patients for a surgery center. That's still a $2 billion dollar savings. From just 10% of a single procedure.

There was a large DPC group in Washington State that partnered with Medicaid exactly as you described. Last I heard was that they cut primary care costs for Medicaid by around 18%. That won't save all of healthcare, but it certainly helps.

When you put it that way, allowing "skimpy" plans that may not necessarily cover maternity care, etc makes a lot of sense!

 

[Ducttape]

i get it, but not to lose sight, but your advocacy of DPC is to improve the current system. it is not about eliminating medicare. almost everything drusso hates about medicare will not change...

and the focus is on fixing primary care, when the onus and major problem may not be with office visits but with hospital services and specialty (ie interventional) care.

fwiw, Im all for changes such as this, but it seems realistic to consider this a teeny weeny bandage rather than a fix.

after all, if you consider that there were roughly 990 million office visits in the US (estimated by the CDC) in 2017, even at $1000 per visit (10 times Medicare rates), that total would represent 2% of the $3.8 trillion spent on healthcare in the US this year....



I would also ask - is DPC actually a free market system, or just a different way that patients pay a secondary entity to get healthcare? granted, it would cut out most if not all the middlemen, which is a good thing.

 

[hyperalgesia]

I would also ask - is DPC actually a free market system, or just a different way that patients pay a secondary entity to get healthcare? granted, it would cut out most if not all the middlemen, which is a good thing.

What do you mean? If there is little or no govt regulation (other than the usual business) and businesses can compete with lower prices, more marketable docs, etc, I wouldn't call it a "secondary entity". If you are directly paying a business that can compete, that's free market.

I like where this is going. I might even be ok with public catastrophic-ONLY "Medicare for all" if the rest of the market is deregulated. I wouldn't even call it basic care though. It would have to be for unforeseen situations - true insurance. The sacrifice for liberals would be to let go of the preventative care dogma that can encompass everything and destroy the marketplace that we're trying to nurture.

 

[VA Hopeful Dr]

i get it, but not to lose sight, but your advocacy of DPC is to improve the current system. it is not about eliminating medicare. almost everything drusso hates about medicare will not change...

and the focus is on fixing primary care, when the onus and major problem may not be with office visits but with hospital services and specialty (ie interventional) care.

fwiw, Im all for changes such as this, but it seems realistic to consider this a teeny weeny bandage rather than a fix.

after all, if you consider that there were roughly 990 million office visits in the US (estimated by the CDC) in 2017, even at $1000 per visit (10 times Medicare rates), that total would represent 2% of the $3.8 trillion spent on healthcare in the US this year....



I would also ask - is DPC actually a free market system, or just a different way that patients pay a secondary entity to get healthcare? granted, it would cut out most if not all the middlemen, which is a good thing.

Yes but insurance pays way more than Medicare for a visit and the amount spent includes ancillaries - and we PCP types do love our labs.

I advocate primarily DPC because its what I know and its common enough that we have some good experience with it. I actually like free market medicine in all its forms, I just have less experience with other areas.

As for free market, yes DPC absolutely is. For the most part, its a bunch of solo/small practices that set rates at what they calculate will cover costs and afford them a decent PCP salary. There were 2 other DPC practices in my town when I was still doing that. We all had slightly different rates that covered slightly different things - I didn't charge for the kenalog in joint injections while the other groups did. One of the groups involved would cover basic xrays while the other 2 of us didn't. Patients contracted directly with us. So that aspect is absolutely free market.

The larger employer group DPC is usually less free market, you're correct there - although there are enough large companies that offer this that there is some decent competition. That's more along the lines of just price transparency combined with cutting out several layers of middlemen (insurance) who add costs. Think about how much less y'all could charge overall if you didn't need billing people or EMRs that were certified to submit bills to insurance/government.

 

[drusso]

Charging for human experimentation is fleecing.

I just can't let this go because it is such ripe Bull$hit and so destructive to MD/DO scope of practice issues...

Doctors "experiment" all the time on their patients. In fact, our MOC process even REQUIRES it! We are supposed to innovate in how we do things, measure outcomes, and decide if the innovation was "good" for our practice. Maybe you try a new anchoring technique, maybe you "borrow" a product or technique used in derm, vascular, or some other specialty and apply it to your practice, etc...

The basic science of Regen Med is wound care. More than two decades ago, many many practitioners began questioning the "steroid dogma" for MSK conditions and tendinopathies. They "borrowed" PRP from derm/plastics and wound care based upon pre-clinical data generated in equine and veterinary science...

The day we start telling doctors that their 16 years of training precludes them from innovating and experimenting in how they care for patients, is the day that all MD/DO's are reduced to mid-levels. I don't think you want to see that.

Owning a doctoral medical degree does not absolve one of important ethical and medico-legal obligations. In fact, it holds us to a higher standard. Who wakes up in the morning (except for maybe Dr. Berman) and says, "Hey, let's go to the office and blind some people by shoving fat globs in their eyeballs?" That's not experimentation, innovation, or "borrowing" from other specialties, that's psychopathic dangerous maiming of innocent people.

If we don't change our rhetoric around MD/DO scope of practice and innovation/experimentation versus psychopathic maiming of patients in MSK/Pain/Regen Med, then we are one step closer to handing our testicles over to the Nanny-state to regulate us like a public utility and realize the Democratic Socialist ideal/dream of all doctors working for the Post Office.

Until then I've still got the Second Amendment, an unrestricted license to practice medicine, a vial of 10X PRP in my hand, an ultrasound machine, and a patient with a hamstring tendinopathy in Room 3 who has failed 2 blind cortisone shots by a mid-level ortho PA, six weeks of PT, and is praying to God that a PRP injection is going to help her.

If @lobelsteve wants to stop me, he's going to have to come here and pry this autologous blood/platelet product from my cold, dead hand...

 

[VA Hopeful Dr]

I just can't let this go because it is such ripe Bull$hit and so destructive to MD/DO scope of practice issues...

Doctors "experiment" all the time on their patients. In fact, our MOC process even REQUIRES it! We are supposed to innovate in how we do things, measure outcomes, and decide if the innovation was "good" for our practice. Maybe you try a new anchoring technique, maybe you "borrow" a product or technique used in derm, vascular, or some other specialty and apply it to your practice, etc...

The basic science of Regen Med is wound care. More than two decades ago, many many practitioners began questioning the "steroid dogma" for MSK conditions and tendinopathies. They "borrowed" PRP from derm/plastics and wound care based upon pre-clinical data generated in equine and veterinary science...

The day we start telling doctors that their 16 years of training precludes them from innovating and experimenting in how they care for patients, is the day that all MD/DO's are reduced to mid-levels. I don't think you want to see that.

Owning a doctoral medical degree does not absolve one of important ethical and medico-legal obligations. In fact, it holds us to a higher standard. Who wakes up in the morning (except for maybe Dr. Berman) and says, "Hey, let's go to the office and blind some people by shoving fat globs in their eyeballs?" That's not experimentation, innovation, or "borrowing" from other specialties, that's psychopathic dangerous maiming of innocent people.

If we don't change our rhetoric around MD/DO scope of practice and innovation/experimentation versus psychopathic maiming of patients in MSK/Pain/Regen Med, then we are one step closer to handing our testicles over to the Nanny-state to regulate us like a public utility and realize the Democratic Socialist ideals of all doctors working for the Post Office.

Until then I've still got the Second Amendment, an unrestricted license to practice medicine, a vial of 10X PRP in my hand, an ultrasound machine, and a patient with a hamstring tendinopathy in Room 3 who has failed 2 blind cortisone shots by mid-level ortho PA, six weeks of PT and praying to God that a PRP injection is going to help her.

If @lobelsteve wants to stop me, he's going to have to come here and pry this autologous blood/platelet product from my cold, dead hand...

Interestingly, BCBS in my state just told us today that trigger point injections are Experimental and so they weren't going to pay for them anymore

 

[Dr. Ice]

I just can't let this go because it is such ripe Bull$hit and so destructive to MD/DO scope of practice issues...

Doctors "experiment" all the time on their patients. In fact, our MOC process even REQUIRES it! We are supposed to innovate in how we do things, measure outcomes, and decide if the innovation was "good" for our practice. Maybe you try a new anchoring technique, maybe you "borrow" a product or technique used in derm, vascular, or some other specialty and apply it to your practice, etc...

The basic science of Regen Med is wound care. More than two decades ago, many many practitioners began questioning the "steroid dogma" for MSK conditions and tendinopathies. They "borrowed" PRP from derm/plastics and wound care based upon pre-clinical data generated in equine and veterinary science...

The day we start telling doctors that their 16 years of training precludes them from innovating and experimenting in how they care for patients, is the day that all MD/DO's are reduced to mid-levels. I don't think you want to see that.

Owning a doctoral medical degree does not absolve one of important ethical and medico-legal obligations. In fact, it holds us to a higher standard. Who wakes up in the morning (except for maybe Dr. Berman) and says, "Hey, let's go to the office and blind some people by shoving fat globs in their eyeballs?" That's not experimentation, innovation, or "borrowing" from other specialties, that's psychopathic dangerous maiming of innocent people.

If we don't change our rhetoric around MD/DO scope of practice and innovation/experimentation versus psychopathic maiming of patients in MSK/Pain/Regen Med, then we are one step closer to handing our testicles over to the Nanny-state to regulate us like a public utility and realize the Democratic Socialist ideals of all doctors working for the Post Office.

Until then I've still got the Second Amendment, an unrestricted license to practice medicine, a vial of 10X PRP in my hand, an ultrasound machine, and a patient with a hamstring tendinopathy in Room 3 who has failed 2 blind cortisone shots by a mid-level ortho PA, six weeks of PT and praying to God that a PRP injection is going to help her.

If @lobelsteve wants to stop me, he's going to have to come here and pry this autologous blood/platelet product from my cold, dead hand...

I tried to like this more than once..but SDN wouldn’t let me

 

[drusso]

Get off my lawn!
The majority of the population now can't afford healthcare so PP is dead, and we're all just standing around waiting for the funeral

Fearing ‘blue wave,’ drug, insurance companies build single-payer defense

The website of the Partnership for America’s Health Care Future does not directly say that it is intended to fight single-payer, instead using less direct phrases like “building on the strength of employer-provided health coverage.” But lobbyists say that the purpose of the group is to push back on single-payer.

 

[lobelsteve]

I just can't let this go because it is such ripe Bull$hit and so destructive to MD/DO scope of practice issues...

Doctors "experiment" all the time on their patients. In fact, our MOC process even REQUIRES it! We are supposed to innovate in how we do things, measure outcomes, and decide if the innovation was "good" for our practice. Maybe you try a new anchoring technique, maybe you "borrow" a product or technique used in derm, vascular, or some other specialty and apply it to your practice, etc...

The basic science of Regen Med is wound care. More than two decades ago, many many practitioners began questioning the "steroid dogma" for MSK conditions and tendinopathies. They "borrowed" PRP from derm/plastics and wound care based upon pre-clinical data generated in equine and veterinary science...

The day we start telling doctors that their 16 years of training precludes them from innovating and experimenting in how they care for patients, is the day that all MD/DO's are reduced to mid-levels. I don't think you want to see that.

Owning a doctoral medical degree does not absolve one of important ethical and medico-legal obligations. In fact, it holds us to a higher standard. Who wakes up in the morning (except for maybe Dr. Berman) and says, "Hey, let's go to the office and blind some people by shoving fat globs in their eyeballs?" That's not experimentation, innovation, or "borrowing" from other specialties, that's psychopathic dangerous maiming of innocent people.

If we don't change our rhetoric around MD/DO scope of practice and innovation/experimentation versus psychopathic maiming of patients in MSK/Pain/Regen Med, then we are one step closer to handing our testicles over to the Nanny-state to regulate us like a public utility and realize the Democratic Socialist ideal/dream of all doctors working for the Post Office.

Until then I've still got the Second Amendment, an unrestricted license to practice medicine, a vial of 10X PRP in my hand, an ultrasound machine, and a patient with a hamstring tendinopathy in Room 3 who has failed 2 blind cortisone shots by a mid-level ortho PA, six weeks of PT, and is praying to God that a PRP injection is going to help her.

If @lobelsteve wants to stop me, he's going to have to come here and pry this autologous blood/platelet product from my cold, dead hand...

Passionate and misguided. Only time will tell.

 

[drusso]

to go back in a time there was a free market for medicare, one has to go to the 1965. at that time, 40% of the elderly did not have any health insurance and possible care. they didn't worry about evil free market. they just went without - completely.

Numbers 'going private' for surgery soaring as NHS rationing deepens


"The number of patients paying for operations privately is soaring amid rising waiting lists and deepening rationing across the NHS, new figures show. Private companies have seen a 53 per cent rise in the “self-pay” market in four years, the data reveals."

...it's so obvious that single payer is a failure, but the Democratic Socialists who post here will clamor, "We just need to try **OUR** version of socialism...all the others got it wrong!"

Let's not forget Ronnie's sage advice...socialized medicine is a foot in the door to a broader socialist agenda.

 

[Ducttape]

Medicare Celebrates Its 50th Birthday, Despite Ronald Reagan


Why do narrow minded conservatives only point to Britain as their example of failure of socialized medicine? Why not look at Swiss or Singapore?

Oh wait. It fits their myopic narrative...

https://www.google.com/amp/s/www.fo...care-are-economically-freer-than-the-u-s/amp/

 

[Aether2000]

The major barriers to socialized medicine in the US are patient expectations of being able to sue (most socialized medicine countries have severe restrictions on this) and insurer political clout. Free markets cannot work in the US healthcare system because patients with insurance or social coverage programs (95% of the population) can never make informed and unfettered choices about healthcare options. Only the uninsured have the ability to participate in a free market, but ironically in the US this group is charged the most by doctors and hospitals. Free markets do not work in US healthcare.

 

[drpainfree]

Medicare Celebrates Its 50th Birthday, Despite Ronald Reagan


Why do narrow minded conservatives only point to Britain as their example of failure of socialized medicine? Why not look at Swiss or Singapore?

Oh wait. It fits their myopic narrative...

https://www.google.com/amp/s/www.fo...care-are-economically-freer-than-the-u-s/amp/

because socialized of anything can work much better and efficiently in an homogeneous society.

it's much easier to implement and enforce a rule in a country with strictly enforced laws.

did you know you are not allowed to chew gums in public in Singapore?

Apply that to anything health-related? No smoking, no alcohol, no opioids, etc. and etc...then you have a perfect society with government-engineered lifestyle universally applied to all citizens. sure, you can cut cost down, and reduce per-capita expenditure, are we ready to sacrifice personal freedom for "socializing" everything?

 

[VA Hopeful Dr]

The major barriers to socialized medicine in the US are patient expectations of being able to sue (most socialized medicine countries have severe restrictions on this) and insurer political clout. Free markets cannot work in the US healthcare system because patients with insurance or social coverage programs (95% of the population) can never make informed and unfettered choices about healthcare options. Only the uninsured have the ability to participate in a free market, but ironically in the US this group is charged the most by doctors and hospitals. Free markets do not work in US healthcare.

But they could, and without too much effort.

Y'all know better than most the difference between insurance price for an MRI and cash price for an MRI.

Make it so that if a patient shops around and finds a good price for anything elective, they can submit the bill to their insurance company and get that amount applied to their deductible.

There. Now the insured can participate in and enhance the scope of free market healthcare.

 

[hyperalgesia]

The major barriers to socialized medicine in the US are patient expectations of being able to sue (most socialized medicine countries have severe restrictions on this) and insurer political clout. Free markets cannot work in the US healthcare system because patients with insurance or social coverage programs (95% of the population) can never make informed and unfettered choices about healthcare options. Only the uninsured have the ability to participate in a free market, but ironically in the US this group is charged the most by doctors and hospitals. Free markets do not work in US healthcare.

Maybe we need to separate "health care" into emergent, catastrophic and routine categories... I don't know what the percentage is but if 90% of the care that is delivered is routine check ups, medication mgmt, elective procedures, etc, then why should this be any different than any other free market? The remaining market; emergent, catastrophic, could be up for discussion at the state and federal levels.

I would like to see Medicare offer a pilot program to states to allow them to opt out of Medicare and keep the money to try their own programs.

The fact that liberals fail to implement their ideas at the state level is an indication they are not viable ideas.

 

[drusso]

Medicare Celebrates Its 50th Birthday, Despite Ronald Reagan


Why do narrow minded conservatives only point to Britain as their example of failure of socialized medicine? Why not look at Swiss or Singapore?

Oh wait. It fits their myopic narrative...

https://www.google.com/amp/s/www.fo...care-are-economically-freer-than-the-u-s/amp/

Don’t blame capitalism for high health costs

Without competition, choice, and price transparency, our current health sector is hardly an example of free-market capitalism. Rather than moving further in the wrong direction and further consolidating health care in to one mammoth government program such as “Medicare for All,” we should move to reinvigorate competition by removing bureaucratic burdens, restoring meaningful individual choice and empowering patients with the best information about their care and the costs."

 

[Ducttape]

isn't that the holy grail of capitalism?

please, name me one market that is a free-market capitalistic one without big conglomerates dominating the market, that is truly capitalistic to encompass what you are looking for...

internet/cable tv?
phone?
gas/electric?
grocery stores?
retail?
restaurants?



then, what would be the plan for the 40-60% of the population that cannot afford healthcare, including most people over age 65?

 

[hyperalgesia]

isn't that the holy grail of capitalism?

please, name me one market that is a free-market capitalistic one without big conglomerates dominating the market, that is truly capitalistic to encompass what you are looking for...

internet/cable tv?
phone?
gas/electric?
grocery stores?
retail?
restaurants?

then, what would be the plan for the 40-60% of the population that cannot afford healthcare, including most people over age 65?

Lasik providers, barber shops, dental, chiro, auto mechanics, grocery stores, retail, restaurants are all good examples of competitive, relatively free markets. Internet/utilities are not good examples of free markets because of barrier to entry.

Here's my plan:
-Make Medicare for all for just catastrophic care (cancer, etc) with strict criteria
-Say good bye to the insurance industry since catastrophic is already covered
-Without private insurance companies, is there still a need for HIPAA?
-Deregulate medical practices
-Encourage independent businesses for more competition, choices and value
-Make market protectionist measures illegal like CONs so there's a cash MRI center on every corner - lower prices

40-60% of the population can't afford healthcare because the market has been decimated by govt. Same is true with "education". We can't keep throwing money at these socialist dreams and watch it evaporate.

The idea that we abandon the core American value of free market capitalism and try to follow Denmark and Sweden and Canada, even after the tremendous successes of free market capitalism, and the abject failure of socialist experiments in our own country, is preposterous. Medicare is NOT SUSTAINABLE. It was worth a try...

 

[DOctorJay]

Sweden
https://www.politico.eu/article/swe...ty-undoing-peaceful-self-image-law-and-order/

 

[Ducttape]

Lasik providers, barber shops, dental, chiro, auto mechanics, grocery stores, retail, restaurants are all good examples of competitive, relatively free markets. Internet/utilities are not good examples of free markets because of barrier to entry.

Here's my plan:
-Make Medicare for all for just catastrophic care (cancer, etc) with strict criteria
-Say good bye to the insurance industry since catastrophic is already covered
-Without private insurance companies, is there still a need for HIPAA?
-Deregulate medical practices
-Encourage independent businesses for more competition, choices and value
-Make market protectionist measures illegal like CONs so there's a cash MRI center on every corner - lower prices

40-60% of the population can't afford healthcare because the market has been decimated by govt. Same is true with "education". We can't keep throwing money at these socialist dreams and watch it evaporate.

The idea that we abandon the core American value of free market capitalism and try to follow Denmark and Sweden and Canada, even after the tremendous successes of free market capitalism, and the abject failure of socialist experiments in our own country, is preposterous. Medicare is NOT SUSTAINABLE. It was worth a try...

So things like sports clips, great clips, Publix, Kroger’s, McDonald’s, Burger King, chili’s, chix-fil-a, Applebee’s, etc don’t exist?

The fact is that, with the exception of the medical/dental examples you give, in each of these there are groups that drive the market, and the little guys are really still at mercy of big corporations.

I am all for changing care to catastrophic care only, but I don’t think you understand that even with very inexpensive healthcare in a pure free market economy, a huge portion of the population will still not be able to afford any healthcare. 21 million Americans over age 65 had income less than $22,000 per year in 2016. 7 million elderly were living in poverty...

15% of all American - 43 million - live in poverty right now.

What will we do if it is a true free market economy without coverage or some form of backup for these people?

 

[hyperalgesia]

So things like sports clips, great clips, Publix, Kroger’s, McDonald’s, Burger King, chili’s, chix-fil-a, Applebee’s, etc don’t exist?

The fact is that, with the exception of the medical/dental examples you give, in each of these there are groups that drive the market, and the little guys are really still at mercy of big corporations.

I am all for changing care to catastrophic care only, but I don’t think you understand that even with very inexpensive healthcare in a pure free market economy, a huge portion of the population will still not be able to afford any healthcare. 21 million Americans over age 65 had income less than $22,000 per year in 2016. 7 million elderly were living in poverty...

15% of all American - 43 million - live in poverty right now.

What will we do if it is a true free market economy without coverage or some form of backup for these people?

The examples of restaurants and grocery stores seem to illustrate my point. These businesses are competing to the point where McDonalds has a "dollar menu" with reasonably good stuff and available in every city. Are you suggesting the govt should step in and "fix" and redistribute these businesses to make them more like American healthcare and education?

I guess I have a lot of faith in the free market and faith in charity. I believe health care costs in a free market would plummet, "necessary" care would be redefined, and quality and access to care would improve. I just think results will be superior to a socialist model.

All the institutions that have been erected to "save" people: insurance companies, RVUs, meaningful use, EHRs, HIPAA, etc - have helped exactly no one. You can say patients are "covered" and write a paper based on US Census data but I think they're worse off overall.

 

[drusso]

Lessons From the Canadian Experience With Single-Payer Health Insurance

"At present, the Canadian health system typically runs at full capacity but with little resiliency. Months-long waits for outpatient specialist appointments and hospital care delivered on gurneys in hallways are everyday phenomena. Far more patients in Canada (39%) than in the United States (6%), the United Kingdom (19%), or any other country in an international comparison conducted in 2016 reported waiting at least 2 months to see a specialist."

 

[SSdoc33]

All the institutions that have been erected to "save" people: insurance companies, RVUs, meaningful use, EHRs, HIPAA, etc - have helped exactly no one. You can say patients are "covered" and write a paper based on US Census data but I think they're worse off overall.

Medicare is wildly popular and successful and has saved countless lives. an indigent 70 year isnt "worse off overall".

i think ducttape's point in this whole string is that "socialized" medicine benefits the indigent. it probably doesnt help those who can afford better insurances and it probably doesnt improve overall care in that subset

 

[SSdoc33]

Lessons From the Canadian Experience With Single-Payer Health Insurance

"At present, the Canadian health system typically runs at full capacity but with little resiliency. Months-long waits for outpatient specialist appointments and hospital care delivered on gurneys in hallways are everyday phenomena. Far more patients in Canada (39%) than in the United States (6%), the United Kingdom (19%), or any other country in an international comparison conducted in 2016 reported waiting at least 2 months to see a specialist."

we have better specialty care here (mainly because in is remunerated better). they have better primary care. which is more important?

 

[lonelobo]

The examples of restaurants and grocery stores seem to illustrate my point. These businesses are competing to the point where McDonalds has a "dollar menu" with reasonably good stuff and available in every city. Are you suggesting the govt should step in and "fix" and redistribute these businesses to make them more like American healthcare and education?

I guess I have a lot of faith in the free market and faith in charity. I believe health care costs in a free market would plummet, "necessary" care would be redefined, and quality and access to care would improve. I just think results will be superior to a socialist model.

All the institutions that have been erected to "save" people: insurance companies, RVUs, meaningful use, EHRs, HIPAA, etc - have helped exactly no one. You can say patients are "covered" and write a paper based on US Census data but I think they're worse off overall.

That doesn't help your argument...lol

 

[Ducttape]

The examples of restaurants and grocery stores seem to illustrate my point. These businesses are competing to the point where McDonalds has a "dollar menu" with reasonably good stuff and available in every city. Are you suggesting the govt should step in and "fix" and redistribute these businesses to make them more like American healthcare and education?

I guess I have a lot of faith in the free market and faith in charity. I believe health care costs in a free market would plummet, "necessary" care would be redefined, and quality and access to care would improve. I just think results will be superior to a socialist model.

All the institutions that have been erected to "save" people: insurance companies, RVUs, meaningful use, EHRs, HIPAA, etc - have helped exactly no one. You can say patients are "covered" and write a paper based on US Census data but I think they're worse off overall.

my point is that even in the most capitalistic market there are big corporations that have the power to drive the little man out of business, that can overwhelm the little man. the corner deli is rare nowadays. its a Fasttrac or Speedway. there used to be diners at every street corner. now, its the yellow arches or BK. the dollar menu was not created to compete against the little guy and small restaurants. they were to compete against other big corporations, after all the little guys were gone. fwiw, what is the likelihood that a small business restaurant will fail? - 30% in 1 year, 50% in 3, 70% by 10 years. those are horrible odds.



you see, I don't have the same faith in people, from what I have seen.

let me rephrase... I see a lot of doctors who dedicate themselves to helping people, who make willing sacrifices to help their patients. unfortunately, most of them are in internal medicine or ER medicine or pediatrics. I see a lot of doctors who are so focused on financial renumeration that it clouds their judgement as to quality care (yes, ortho, spine surg, and even our profession of interventional spine or opioid "management"/pill mill).

it is important to look at history to see what happened in the past. the state of medicine has made advances, yes, but the initiation of medicare meant that a lot more elderly people were allowed access to healthcare when they had retired.

I am not suggesting the government step in. they are already knee deep in healthcare. what in my opinion should be done is to not decide that healthcare is a commodity that can be traded, bought or sold, but that parts of health care should be considered as basic human need. specifically, make preventative medicine and catastrophic medicine only as a "right", instead of something that can be bought or sold. that would make what we do a lot of fluff.......

 

[hyperalgesia]

I want to have faith in free markets, and believe that doctors will do the right thing when unburdened from regulation and oversight, but in my region- as I have stated many times before- it is the PP IPM practices which are predatory. These practices, driven by financial appetite are the ones with out of control mid levels keeping everyone on opioids while they get injections, discharging patients for spurious reasons and dumping them into the community, routinely doing series of 3, partnering with Ortho groups and implanting poor SCS candidates, putting pumps in and then summarily discharging patients who have hypertensive crises from clonidine withdrawal...I could go on.

To me, your example is an illustration of how oversight does NOT work. Who is paying for all these outrageous things? Who is watching every dollar as if they earned it? Not a free market!

 

[Ducttape]

To me, your example is an illustration of how oversight does NOT work. Who is paying for all these outrageous things? Who is watching every dollar as if they earned it? Not a free market!

Wow.

I guess anything can be utilized to justify ones stance. the lack of monitoring does not lead to the existence of such monitoring occurring. A false assumption.

 

[deleted103644]

Wow.

I guess anything can be utilized to justify ones stance. the lack of monitoring does not lead to the existence of such monitoring occurring. A false assumption.

"It is difficult to get a man to understand something, when his salary depends upon his not understanding it!"

 

[drusso]

drusso hit the nail on the head when justifying his naked and limbic proselytizing for the free market: he wants to be prosperous. Well, I know several "free market" adherents in my local area who are very "prosperous." They run pill mills, UDS scams and inject, stim and pump everything with a deductible- until it runs out and they dump them into the community. For every Algos, there are 10 con artists

Instead of venting your spleen and hormonal rage against hospital systems drusso, maybe you should focus more of your energy on the shamans and charlatans within this specialty- and those advertising themselves as such- who invite government regulation and procedural retrenchment through their absurd overuse/misuse of procedures and medications- all in the name of $$$

Now, you're against "prosperity" too? I guess that we just can't agree on anything...smh...

 

[hyperalgesia]

Wow.

I guess anything can be utilized to justify ones stance. the lack of monitoring does not lead to the existence of such monitoring occurring. A false assumption.

I never said that lack of monitoring caused or led to anything. You made the false assumption.

My point is that the examples of predatory medicine happen in our current environment, under the watchful observation of CMS and/or the insurance industry.

In other words, the examples do not argue against a free market in medicine. They don't SUPPORT CMS and current regulatory measures.

My position is that, in a free market, where the individual patient is responsible for cost, there would be fewer "series of 3". And when a person got a SO3, that was ineffective and cost them money, it would not be dismissed by the patient as, "oh well worth a try". Patients would not choose that practice.

 

[Ducttape]

I never said that lack of monitoring caused or led to anything. You made the false assumption.

My point is that the examples of predatory medicine happen in our current environment, under the watchful observation of CMS and/or the insurance industry.

In other words, the examples do not argue against a free market in medicine. They don't SUPPORT CMS and current regulatory measures.

My position is that, in a free market, where the individual patient is responsible for cost, there would be fewer "series of 3". And when a person got a SO3, that was ineffective and cost them money, it would not be dismissed by the patient as, "oh well worth a try". Patients would not choose that practice.

not to be condescending, but what universe do you live in? patients will try anything and everything if it is promised by a trained professional, especially if that is a doctor.

doctors and others do what is best for them. there is no true altruism that comes with any economy in which there is fee for service.

yes yes I know, you had a patient once who couldn't pay for an injection, so you did it for free. woopie, but that 1. didn't happen in a free market economy (cause we don't have one) and 2. it is not a standard model because at the very least it is not sustainable in a private practice.

(if you are thinking of Carnegie, Rockefeller Mellon etc., even Gates and Zuckerberg - their altruism came after they made their millions, not while doing so)

 

[hyperalgesia]

not to be condescending, but what universe do you live in? patients will try anything and everything if it is promised by a trained professional, especially if that is a doctor.

doctors and others do what is best for them. there is no true altruism that comes with any economy in which there is fee for service.

yes yes I know, you had a patient once who couldn't pay for an injection, so you did it for free. woopie, but that 1. didn't happen in a free market economy (cause we don't have one) and 2. it is not a standard model because at the very least it is not sustainable in a private practice.

(if you are thinking of Carnegie, Rockefeller Mellon etc., even Gates and Zuckerberg - their altruism came after they made their millions, not while doing so)

I agree that for the most part people are selfish but there is still a tremendous reservoir of charity IMO. How else do you explain the ridiculous number of charitable organizations/churches/etc?

My personal view is that society is going to hell in a hand basket because the govt has convinced so many people that, if it weren't so active in good deeds, people would eat each other.