Comments on: Where are the Physician Leaders? http://gruntdoc.com/2005/10/where-are-the-physician-leaders.html Ramblings of an Emergency Physician in Texas Fri, 10 Feb 2012 00:40:33 +0000 hourly 1 http://wordpress.org/?v=3.3.1 By: DOW http://gruntdoc.com/2005/10/where-are-the-physician-leaders.html/comment-page-1#comment-2829 DOW Tue, 01 Nov 2005 19:40:51 +0000 http://gruntdoc.com/2005/10/where-are-the-physician-leaders.html#comment-2829 These are some of the straightest and most intelligent comments I've seen in a long time on a staggeringly complex problem. No system is going to work perfectly, but some do certainly work better than others (according, of course, to the parameters you plug in to define "better"). The existing non-system in the United States does a few things well and a lot horribly -- arguably much worse in terms of promoting the general welfare and longevity of the greatest number than the flawed approaches taken by most other industrialized countries. But Gruntdoc, Greg P and Jim K have it right -- physicians themselves will not be the saviors who untangle the mess for us, for the reasons they clearly articulate. It's refreshing if not soothing to hear challenging realism (which allows for imperfect lurches in the direction of solutions) and not glib certainty when it comes to this issue. These are some of the straightest and most intelligent comments I’ve seen in a long time on a staggeringly complex problem. No system is going to work perfectly, but some do certainly work better than others (according, of course, to the parameters you plug in to define “better”). The existing non-system in the United States does a few things well and a lot horribly — arguably much worse in terms of promoting the general welfare and longevity of the greatest number than the flawed approaches taken by most other industrialized countries. But Gruntdoc, Greg P and Jim K have it right — physicians themselves will not be the saviors who untangle the mess for us, for the reasons they clearly articulate. It’s refreshing if not soothing to hear challenging realism (which allows for imperfect lurches in the direction of solutions) and not glib certainty when it comes to this issue.

]]> By: Jim K http://gruntdoc.com/2005/10/where-are-the-physician-leaders.html/comment-page-1#comment-2828 Jim K Tue, 01 Nov 2005 15:28:38 +0000 http://gruntdoc.com/2005/10/where-are-the-physician-leaders.html#comment-2828 The health care problem will not be solved until someone (as you said, it needs to be a politician) is willing to give voice to the central question that everyone dances around....how will we ration healthcare. Every country in the world rations it (to avoid bankrupting the treasury)but no one puts it in those terms. Unfortunately, saying this guarantees one's opponent election. In the US, we ration it with dollars, in Britain it's done with time. Canada seems to be some hybrid of these. The Nordic countries tried to do no rationing and are now backing off since tax rates cannot excede 100% of income. This gets into value judgements of whose life is worth more. Is it the wealthy - I've got problems with that, but philosophically Bill Gates feeds about 180,000 more people (through employment) than I do so maybe we should keep him healthy before treating me. Is it the young - I imagine the AARP has an opinion on that. Is it the old - they consume most of the health care dollars, but then they created the industries generating those dollars in the first place. I really don't have an answer, I'm just putting possibilites out for discussion. MDs are not in a position to lead this discussion since it contravenes both their education and the reason they became MDs in the first place. Actually giving voice to the idea of rationing health care says clearly that those at the bottom of the que (whatever the criteria used) will be left to die from ailments that those at the top of the que will be cured of. MDs are healers, not killers. The health care problem will not be solved until someone (as you said, it needs to be a politician) is willing to give voice to the central question that everyone dances around….how will we ration healthcare. Every country in the world rations it (to avoid bankrupting the treasury)but no one puts it in those terms. Unfortunately, saying this guarantees one’s opponent election.

In the US, we ration it with dollars, in Britain it’s done with time. Canada seems to be some hybrid of these. The Nordic countries tried to do no rationing and are now backing off since tax rates cannot excede 100% of income.

This gets into value judgements of whose life is worth more. Is it the wealthy – I’ve got problems with that, but philosophically Bill Gates feeds about 180,000 more people (through employment) than I do so maybe we should keep him healthy before treating me. Is it the young – I imagine the AARP has an opinion on that. Is it the old – they consume most of the health care dollars, but then they created the industries generating those dollars in the first place. I really don’t have an answer, I’m just putting possibilites out for discussion.

MDs are not in a position to lead this discussion since it contravenes both their education and the reason they became MDs in the first place. Actually giving voice to the idea of rationing health care says clearly that those at the bottom of the que (whatever the criteria used) will be left to die from ailments that those at the top of the que will be cured of. MDs are healers, not killers.

]]> By: Greg P http://gruntdoc.com/2005/10/where-are-the-physician-leaders.html/comment-page-1#comment-2827 Greg P Sun, 30 Oct 2005 23:28:27 +0000 http://gruntdoc.com/2005/10/where-are-the-physician-leaders.html#comment-2827 One of the problems (out of many) that we docs have is that our point of view is felt to be tainted. The "rules" of healthcare are set mainly by the payors, ie, the government and insurance companies. What I would mainly like to see is a level playing field in as many areas as possible, so that I have a single fee for each service I perform, regardless of the type or even presence of health insurance. This would greatly simplify the billing process. Furthermore, the price for health insurance should be the same for everyone -- a company could refuse to sell insurance to someone, but if they offered it, it should be no more expensive than someone at Ford or GM pays. It's hard to know what to do about universal health care. There are many now who could afford to buy insurance but choose not to. When they get significantly ill, it's a catastrophe, but they're willing to take the chance. Doctors are the ones least likely to get paid in these situations. There's a substantial money-grab going on. It seems everyone (hospitals, private companies, doctors) wants to open their own MRI scanning facility where I am. I would prefer to see someone tackle the cost of an MRI (it's really outrageous) rather than simply trying to profit from it. One of the problems (out of many) that we docs have is that our point of view is felt to be tainted.
The “rules” of healthcare are set mainly by the payors, ie, the government and insurance companies.

What I would mainly like to see is a level playing field in as many areas as possible, so that I have a single fee for each service I perform, regardless of the type or even presence of health insurance. This would greatly simplify the billing process.

Furthermore, the price for health insurance should be the same for everyone — a company could refuse to sell insurance to someone, but if they offered it, it should be no more expensive than someone at Ford or GM pays.
It’s hard to know what to do about universal health care. There are many now who could afford to buy insurance but choose not to. When they get significantly ill, it’s a catastrophe, but they’re willing to take the chance. Doctors are the ones least likely to get paid in these situations.

There’s a substantial money-grab going on. It seems everyone (hospitals, private companies, doctors) wants to open their own MRI scanning facility where I am. I would prefer to see someone tackle the cost of an MRI (it’s really outrageous) rather than simply trying to profit from it.

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